S5-5
Compliance with Existing Guidelines in Patients with Acute Coronary Syndrome (Unstable Angina and non-ST elevation Myocardial Infarction) – Preliminary Results from the ACCORD Registry
Wen-Ter Lai, Chiung-Jen Wu, Ching-Pei Chen, Kwo-Chang Ueng, Pei-Liang Kuan, Chiau-Suong Liau, Meng-Huan Lei, on behalf of Taiwan ACCORD Registry investigators
Kaoshiung Medical University Hospital, Chang Gung Memorial Hospital-Kaohsiung, Changhua Christian Hospital, Chung Shan Medical University Hospital, Shin Kong Wu Ho-Su Memorial Hospital, National Taiwan University Hospital, Lo-Tung Pohai Hospital |
Category: Interventional cardiology
BACKGROUND: Peterson et al have reported an association between the degree of adherence to ACC/AHA guidelines and better patient outcomes. A national prospective registry was conducted in Taiwan to evaluate the current practices in the management of non ST segment elevation (NSTE) acute coronary syndromes (ACS) and compliance with international guidelines. Evidence-based medications after discharge include combination of aspirin and clopidogrel for at least 9 months, beta-blockers, angiotensin-converting enzymes inhibitors, and lipid-lowering agents in NSTEACS patients.
MATERIALS AND METHODS: From July 2004 to November 2005, 1409 unstable angina or non-Q-wave myocardial infraction patients were enrolled in 27 hospitals and followed-up for one year. Information was recorded about patient management during hospital and long-term care after discharge. Use and reason for discontinuation of antiplatelet therapy was assessed during the one year follow-up.
RESULTS: Of 1409 pts, 68% had a final diagnosis of unstable angina, 31% NSTE myocardial infraction, and 1% ST segment elevation myocardial infarction.
Medications are described in the table below
|
At discharge |
3 months |
6 months |
9 months |
12 months |
ASA only (%) |
16 |
28 |
40 |
57 |
64 |
Clopidogrel only (%) |
18 |
22 |
21 |
21 |
22 |
ASA + clopidogrel (%) |
61 |
50 |
31 |
22 |
14 |
Beta-blockers (%) |
50 |
54 |
54 |
56 |
56 |
ACEI (%) |
35* |
22 |
20 |
19 |
19 |
ARB (%) |
22 |
29 |
31 |
31 |
32 |
Lipid lowering agents (%) |
38 |
43 |
44 |
46 |
47 |
* during hospitalization |
|
|
|
|
|
Combination of aspirin and clopidogrel usage declines markedly over time from 61% at discharge to 22% at 9 months follow-up. Aspirin was mainly discontinued because of safety. Reasons given for discontinuation of clopidogrel were mainly BNHI or hospital guidelines restrictions, patient condition stable or improved and physician’s decision.
CONCLUSION: Gap between evidence and practice exists in Taiwan. Adherence to dual antiplatelet therapy is declining over time. Better adherence to guidelines may improve patient outcomes in ACS.
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