Missed opportunity: a clinical data linkage study of guideline‐directed medical therapy and clinical outcomes of patients discharged with acute coronary syndrome who attended cardiac rehabilitation programs

Author:

Gebremichael Lemlem G.1ORCID,Beleigoli Alline1ORCID,Foote Jonathon W.1ORCID,Bulamu Norma B.2ORCID,Ramos Joyce S.1ORCID,Suebkinorn Orathai1ORCID,Redfern Julie3ORCID,Clark Robyn A.14ORCID,

Affiliation:

1. Caring Futures Institute, College of Nursing and Health Sciences Flinders University Adelaide Australia

2. College of Medicine and Public Health Flinders University Adelaide Australia

3. Public Health Department University of Sydney Sydney Australia

4. Southern Adelaide Local Health Network Adelaide Australia

Abstract

AbstractBackgroundAlthough guidelines recommend guideline‐directed medical therapy (GDMT) for patients with acute coronary syndrome (ACS), implementation is limited in clinical practice.AimTo assess the level of GDMT in ACS patients after discharge who attended cardiac rehabilitation (CR) programs and association with clinical outcomes.MethodA cross‐sectional study was conducted in 13 rural and 10 metropolitan CR programs via all modes of delivery (face‐to‐face, telephone, or general practice‐hybrid) operating in South Australia, Australia. ACS patients were included if they were ≥18 years of age and were referred and attended CR programs with medication details recorded in their hospital discharge summary. GDMT was assessed according to the Australian clinical guidelines for the management of acute coronary syndromes 2016. Prescription of all the four recommended medication classes was considered optimal. Logistic regression and χ2 test were used for association. Ethical approval was granted by the South Australian Department for Health and Wellbeing Human Research Ethics Committee (Reference No. HREC/15/SAH/63) and the Northern Territory Department of Health Human Research Ethics Committee (Reference No. HREC 2015‐2484) which included a waiver of consent per the National Statement on Ethical Conduct in Human Research and the study conforms with the Good Clinical Practice Guidelines.ResultsOf the 1229 patients included, 74.6% were male and 41.1% had acute myocardial infarction. Only 39.7% of patients received optimal prescription. Prescription of any three or two medication class combinations occurred for 78.3% and 94.1% of patients, respectively. Optimal GDMT was associated with fewer hospital admissions (odds ratio = 0.647, 95% confidence interval 0.424–0.987, p = 0.043) with no significant gender association. Women were less likely to be prescribed angiotensin converting enzyme inhibitors (p = 0.003), angiotensin receptor blockers (p = 0.007), statins (p = 0.005), and any two (p < 0.001) and three combinations (p = 0.023) of medication classes.ConclusionGDMT prescription was suboptimal in patients with ACS before attendance at CR. Primary care and CR clinicians have missed an opportunity to implement best practice guideline recommendations, particularly for women.

Funder

National Health and Medical Research Council

Publisher

Wiley

Reference26 articles.

1. World Health Organization (WHO).Cardiovascular diseases. Geneva: WHO; 2021. Available from . Accessed 12 July 2021.

2. National Institute for Health and Care Excellence (NICE).Acute Coronary Syndromes: NICE guideline [NG185]. London: NICE;2020. Available from .

3. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

4. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR guideline for the evaluation and diagnosis of CHEST pain: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines;Gulati M;Circulation,2021

5. National Heart Foundation of Australia & Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Management of Acute Coronary Syndromes 2016

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