Predictors, cost, and outcomes of patients with acute coronary syndrome who receive optimal secondary prevention therapy: results from the antiplatelet treatment observational registries (APTOR).
BACKGROUND
We sought to evaluate outcomes, costs of care, quality of life and predictors at 12 months in patients with an acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI) and evaluated use of optimal secondary prevention therapy, defined as use of aspirin and clopidogrel along with ≥ 3 of the following 4 therapies at both hospital discharge and at one-year post-PCI: statins, beta-blockers, ARB/ACE-inhibitors, and exercise or diet.


METHODS
Data were from the prospective, observational APTOR study of 14 European countries from 2007 to 2009 (n=4184 patients).


RESULTS
Optimal therapy was received in 43% of patients. Use of optimal therapy varied significantly by country. Diet or exercise at 1 year was more likely prescribed to the optimal cohort (34% vs 16%) as was dual antiplatelet therapy (99% vs 49%). Rates of CV event (3.1% vs 3.5%), bleeding (2.9% vs 2.8%) and mortality (0.9% vs 1.3%) at 1 year were similar between the optimal and non-optimal cohorts, respectively. Total costs were similar for both cohorts, but differences in post-discharge costs were observed (optimal: £1760 [£1682-£1844]; non-optimal: £1492 [£1434-£1554]), primarily due to post-discharge medication and resource use.


CONCLUSIONS
In conclusion, in this contemporary, European ACS-PCI registry, optimal therapy was low (<50%) overall, particularly for diet or exercise and dual antiplatelet therapy, highlighting a considerable gap between evidence-based guidelines and implementation of such treatments. Whether this gap reflects a missed opportunity to improve patient outcomes or whether it reflects appropriate deviation from guidelines by front-line clinicians requires further investigation.
Institut für Herzinfarktforschung, Ludwigshafen, Germany. Electronic address: uwe.zeymer@t-online.de.
Uwe
U
Zeymer
Guy
G
Berkenboom
Zdeněk
Z
Coufal
Mark
M
Belger
Magali
M
Sartral
Kirsi
K
Norrbacka
Ameet
A
Bakhai
D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000191:economics* / Q000517:prevention & control; D000319:Adrenergic beta-Antagonists / Q000191:economics / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000191:economics / Q000627:therapeutic use; D001241:Aspirin / Q000191:economics / Q000627:therapeutic use; D000077144:Clopidogrel; D005060:Europe; D005260:Female; D017048:Health Care Costs; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000191:economics; D010975:Platelet Aggregation Inhibitors / Q000191:economics* / Q000627:therapeutic use*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D012042:Registries; D055502:Secondary Prevention / Q000191:economics*; D015607:Stents / Q000191:economics; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000191:economics / Q000627:therapeutic use; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
Acute coronary syndrome; Costs; Outcomes; Quality of life; Secondary prevention therapy