title: Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand.
abstract: OBJECTIVE
  To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care.
  
  
  METHODS
  All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care.
  
  
  RESULTS
  For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care.
  
  
  CONCLUSIONS
  Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care.
authors.affiliation: The George Institute for Global Health, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Julie
authors.initials: J
authors.lastname: Redfern
authors.affiliation: The George Institute for Global Health, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Karice
authors.initials: K
authors.lastname: Hyun
authors.affiliation: Department of Cardiovascular Medicine, Flinders University, Southern Adelaide Local Health Network, Adelaide, Australia.
authors.forename: Derek P
authors.initials: DP
authors.lastname: Chew
authors.affiliation: Statewide Cardiac Clinical Network, South Australian Health; Flinders University, Adelaide, Australia.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Astley
authors.affiliation: The George Institute for Global Health, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, Australia Westmead Hospital, Sydney, Australia.
authors.forename: Clara
authors.initials: C
authors.lastname: Chow
authors.affiliation: Cardiology Department, Concord Hospital, Sydney, Australia.
authors.forename: Bernadette
authors.initials: B
authors.lastname: Aliprandi-Costa
authors.affiliation: The George Institute for Global Health, Sydney, Australia Queensland Health, Brisbane, Australia.
authors.forename: Tegwen
authors.initials: T
authors.lastname: Howell
authors.affiliation: Cardiac Network, Agency for Clinical Innovation, Sydney, Australia.
authors.forename: Bridie
authors.initials: B
authors.lastname: Carr
authors.affiliation: Cardiac Network, Agency for Clinical Innovation, Sydney, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Lintern
authors.affiliation: Cardiology Department, Concord Hospital, Sydney, Australia.
authors.forename: Isuru
authors.initials: I
authors.lastname: Ranasinghe
authors.affiliation: The George Institute for Global Health, Sydney, Australia.
authors.forename: Kellie
authors.initials: K
authors.lastname: Nallaiah
authors.affiliation: The George Institute for Global Health, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Turnbull
authors.affiliation: National Heart Foundation of Australia (New South Wales Division) Sydney, Australia.
authors.forename: Cate
authors.initials: C
authors.lastname: Ferry
authors.affiliation: Royal Brisbane Hospital, Brisbane, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Hammett
authors.affiliation: Green Lane CVS Service, Auckland City Hospital, Auckland, New Zealand.
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Ellis
authors.affiliation: Liverpool Hospital Sydney, Australia University of New South Wales, Sydney Australia.
authors.forename: John
authors.initials: J
authors.lastname: French
authors.affiliation: Sydney Medical School, University of Sydney, Sydney, Australia Cardiology Department, Concord Hospital, Sydney, Australia.
authors.forename: David
authors.initials: D
authors.lastname: Brieger
authors.affiliation: School of Population Health, University of Western Australia, Perth, Australia.
authors.forename: Tom
authors.initials: T
authors.lastname: Briffa
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000534:rehabilitation; D000368:Aged; D001315:Australia / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data; D008297:Male; D008330:Management Audit; D008875:Middle Aged; D020380:Needs Assessment; D009520:New Zealand / Q000453:epidemiology; D010351:Patient Discharge / Q000592:standards / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011314:Preventive Health Services / Q000458:organization & administration; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012046:Rehabilitation / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods / Q000458:organization & administration / Q000592:standards
chemical_list: D002317:Cardiovascular Agents