title: [Morbi-mortality and use of recourses after acute coronary syndrome in a Spanish population].
abstract: OBJECTIVE
  To describe the management of patients suffering acute coronary syndrome (ACS) and to determine its clinical and economic consequences in a Spanish population.
  
  
  METHODS
  A multicenter, retrospective claim database study including patient medical records from 6 primary care centers, two hospitals and two years of follow-up was carried out. Patients ≥30 years, suffering a first acute coronary syndrome (ACS), between 2003 and 2007, were included. Groups: acute coronary syndrome with and without ST segment elevation.
  
  
  METHODS
  socio-demographic, co-morbidities, metabolic syndrome (MS), biochemical parameters, drugs, cumulative incidence (total mortality and cardiovascular events (CVE: including myocardial infarction, stroke and peripheral artery disease) and total costs.
  
  
  METHODS
  logistic regression, Kaplan-Meier curves and ANCOVA; (P<.05).
  
  
  RESULTS
  A total of 1020 patients were included. Mean age: 69 years; males: 65%. Groups: ST segment elevation ACS (N=632; 62%). Co-morbidities: hypertension (56%), dyslipidemia (46%) and diabetes (38%). Prevalence of MS: 59% (CI 95%: 56-62%). All biochemical parameters had improved after two years of follow-up. The average total cost per patient was €14,069 (87% direct costs; 13% productivity loss costs). Direct costs: primary care (20%), specialty care (67%); hospitalization costs represented 63% of total costs. The average total cost for patients presenting more than one CVE was 22,750€ vs 12,380€ for those patients who suffered only one (P<.001). Cumulative incidence: total mortality 14%; CVE: 16%.
  
  
  CONCLUSIONS
  In the current clinical practice, and despite the clinical efforts carried out, patients with an ACS are still at a high risk of suffering further CVE, representing a high cost burden to the health care system.
authors.affiliation: Dirección de Planificación, Badalona Serveis Assistencials SA, Barcelona, España. asicras@bsa.cat
authors.forename: A
authors.initials: A
authors.lastname: Sicras-Mainar
authors.forename: J
authors.initials: J
authors.lastname: Fernández de Bobadilla
authors.forename: R
authors.initials: R
authors.lastname: Navarro-Artieda
authors.forename: I
authors.initials: I
authors.lastname: Martín
authors.forename: C
authors.initials: C
authors.lastname: Varela-Moreno
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000191:economics / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000191:economics / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D016896:Treatment Outcome