title: Outcomes, health costs and use of antiplatelet agents in 7,082 patients admitted for an acute coronary syndrome occurring in a large community setting.
abstract: OBJECTIVE
  To assess the outcomes of patients admitted for ACS and the prescription pattern of antiplatelets of patients discharged alive.
  
  
  METHODS
  From the ARNO Observatory database, we performed a record linkage analysis of hospital discharge and prescription databases, which included 2,758,872 subjects of 7 Italian Local Health Authorities. The accrual period lasted from January 1 to December 31, 2008. Discharge records and prescription patterns were analyzed for 1 year before and after the accrual period.
  
  
  RESULTS
  Of 2,758,872 subjects, 7,082 (2.6‰) were hospitalized for ACS. Mean age was 72±13 years, females and diabetics accounted for 36% and 25% of the cases. Of the 7,082 patients, in-hospital death occurred in 6.9%. Of the survivors, 64.5% was treated medically, 35.5% with PCI. Of the patients discharged alive, 65.8% were treated with an antiplatelet, 21.9% aspirin alone, 33.1% aspirin plus a thienopyridine (mostly clopidogrel), 10.5% a thienopyridine alone. Dual antiplatelet treatment was prescribed more frequently in patients treated with PCI than in those treated medically (57.3% vs 19.7%, p<0.0001). At least one re-hospitalization occurred in 58.6% (18.5% for a recurrent episode of ACS, 24.8% for other CV reasons, 15.3% for non CV reasons). Prescription continuity to antiplatelets was observed in 68.0% and 60.3% of the patients, respectively at 6 and 12 months after discharge.
  
  
  CONCLUSIONS
  In a large community setting, the prescription rate of antiplatelets after ACS seems to be far from the guidelines recommendation. Rates of 1 year re-hospitalizations after ACS remain high, recurrence of ACS accounted for just one third of the cases.
authors.affiliation: ANMCO Research Center, Via La Marmora 34, 50121 Florence, Italy. maggioni@anmco.it
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Elisa
authors.initials: E
authors.lastname: Rossi
authors.forename: Elisa
authors.initials: E
authors.lastname: Cinconze
authors.forename: Daniela P
authors.initials: DP
authors.lastname: Roggeri
authors.forename: Alessandro
authors.initials: A
authors.lastname: Roggeri
authors.forename: Gianna
authors.initials: G
authors.lastname: Fabbri
authors.forename: Marisa
authors.initials: M
authors.lastname: De Rosa
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010975:Platelet Aggregation Inhibitors / Q000191:economics / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors