Reinforcing a continuum of care: in-hospital initiation of long-term secondary prevention following acute coronary syndromes.
BACKGROUND
Patients with a history of acute coronary syndrome are particularly susceptible to further vascular or ischemic events. Effective secondary prevention following acute coronary syndrome requires multiple medications targeting the different mechanisms of atherothrombosis. The 2002 American College of Cardiology/American Heart Association guidelines for the management of unstable angina and non ST-segment myocardial infarction and the 2004 guidelines for ST-segment myocardial infarction assign priority to the long-term administration of four critical classes of drugs: antiplatelet agents, in particular aspirin and clopidogrel, beta-blockers, angiotensin-converting enzyme inhibitors, and statins.


CONCLUSIONS
Despite clinical trial evidence demonstrating their ability to reduce cardiovascular morbidity and mortality, available preventive pharmacotherapies remain underutilized. Suboptimal compliance with current recommendations, as with other management guidelines, arises from a host of entrenched physician, patient, and system-related factors. Optimal management of acute coronary syndrome acknowledges a continuum of care in which acute stabilization represents a single important component. Early, in-hospital implementation of secondary preventive measures reinforces the continuum of care approach, promoting a successful transition from treatment to prevention, inpatient to outpatient management, and, when appropriate, subspecialist to generalist care.
Rockson
Stanley G
SG
Division of Cardiovascular Medicine, Falk Cardiovascular Research Center, Stanford University, 300 Pasteur Drive, Stanford, CA 94305, USA. srockson@cvmed.stanford.edu
deGoma
Emil M
EM
Fonarow
Gregg C
GC
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000553:Ambulatory Care; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000069059:Atorvastatin; D002309:Cardiology / Q000592:standards*; D002986:Clinical Trials as Topic; D003266:Continuity of Patient Care; D019468:Disease Management; D019983:Guideline Adherence; D006538:Heptanoic Acids / Q000627:therapeutic use; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000517:prevention & control; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011315:Preventive Medicine; D011758:Pyrroles / Q000627:therapeutic use
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D006538:Heptanoic Acids; D010975:Platelet Aggregation Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin