Persistence of combination of evidence-based medical therapy in patients with acute coronary syndromes.
OBJECTIVE
To analyse long-term adherence persistence of evidence-based medical therapy in 'real-world' patients with coronary disease.


METHODS
Cardiologists recruited the first three consecutive patients seen in either hospital clinics or private practice in 2006 who had been hospitalized for an acute coronary syndrome (ACS) in 2005 in France. Demographic characteristics, medical history, current treatments and medications at hospital discharge were recorded. The primary outcome was the persistence of the combination therapy comprising a beta-blocker, an antiplatelet, a statin and an angiotensin-converting enzyme (ACE) inhibitor (BASI).


RESULTS
A total of 1700 patients were included in this French observational study. The mean time from hospital discharge to consultation was 14+/-4 months. At hospital discharge, BASI had been prescribed in 46.2% of patients, 80.2% of whom were still taking the combination at the consultation. Non-persistence was associated with severe noncardiovascular disease, atrial fibrillation and lack of significant coronary artery stenosis. When analysed separately, beta-blockers, antiplatelets, statins and ACE inhibitors had been prescribed at hospital discharge in 82.4, 98.9, 89.2 and 58%, respectively. Persistence over the 14-months period was greater than 86% for each of the drug classes. After hospital discharge, BASI was initiated in 8.5% of patients. Fourteen months after hospitalization for an ACS, 45.6% of patients were taking BASI.


CONCLUSIONS
Long-term persistence of BASI remained high after hospital discharge for an ACS, whereas the combination was started in a minority of those not discharged on this treatment. Fourteen months after an ACS, only half of the patients were receiving BASI, mainly due to failure to prescribe an ACE inhibitor at discharge. Our results highlight the importance of hospital prescription of BASI to obtain long-term persistence in ACS.
Amar
Jacques
J
Inserm U 558, hôpital Rangueil, CHU de Toulouse, Toulouse, France. amar.j@chu-toulouse.fr
Ferrières
Jean
J
Cambou
Jean-Pierre
JP
Amelineau
Elisabeth
E
Danchin
Nicolas
N
D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D005602:France; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors