International variation in the use of evidence-based medicines for acute coronary syndromes.
OBJECTIVE
We sought to evaluate international patterns of use and factors influencing use of evidence-based medications early after ACS.


RESULTS
Using a database of 15904 ACS patients enrolled in the SYMPHONY and 2nd SYMPHONY trials in 37 countries, we performed descriptive and logistic regression analyses. After controlling for other factors, region was significantly associated with the use of every class of evidence-based medication, most pronounced for intravenous unfractionated heparin (IV UFH), low-molecular-weight heparin (LMWH), angiotensin II converting enzyme inhibitors (ACEI) and discharge use of lipid-lowering agents. Latin America and Eastern Europe were among the highest users of early ACEI, yet the lowest users of discharge lipid-lowering therapy. Relative to the United States, all regions except Canada had greater use of LMWH and lower use of IV UFH. Compared with patients with acute myocardial infarction, those with unstable angina less often received aspirin, beta-blockers, ACEI, or IV UFH. Older age was associated with lower use of aspirin, beta-blockers, IV UFH, and lipid-lowering agents.


CONCLUSIONS
Use of evidence-based therapies for management of ACS patients is strongly associated with region. To improve patient outcomes, more research is needed to understand this variation, and to institute appropriate solutions.
Kramer
Judith M
JM
Duke University Medical Center, Duke Center for Education and Research on Therapeutics, and Duke Clinical Research Institute, NC, Durham, USA. krame009@mc.duke.edu
Newby
L Kristin
LK
Chang
Wei Ching
WC
Simes
R John
RJ
Van de Werf
Frans
F
Granger
Christopher B
CB
Lee
Kerry L
KL
White
Harvey D
HD
Piegas
Leopoldo S
LS
Topol
Eric J
EJ
Califf
Robert M
RM
Armstrong
Paul W
PW
D000368:Aged; D000569:Americas; D001208:Asia; D044362:Australasia; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy*; D005060:Europe; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D011364:Professional Practice; D011379:Prognosis; D012044:Regression Analysis; D012111:Residence Characteristics
D002317:Cardiovascular Agents