title: Increased uptake of guideline-recommended oral antiplatelet therapy: insights from the Canadian acute coronary syndrome reflective.
abstract: Current guideline-based recommendations for oral dual-antiplatelet therapy in an acute coronary syndrome (ACS) include the use of newer adenosine diphosphate receptor inhibitor (ADPri) regimens and agents. The Canadian ACS Reflective Program is a multicenter observational quality-enhancement project that compared the use of ADPri therapy in 2 phases (November 2011-March 2013 and April 2013-November 2013) and also compared ADPri use with previous national data from the Canadian Global Registry of Acute Coronary Events (2000-2008). Of 3099 patients with ACS, 30.6% had ST-segment elevation myocardial infarction (STEMI), 52.3% had non-STEMI, and 17% had unstable angina. There was high use of dual-antiplatelet therapy for ≤ 24 hours, with important increases noted when compared with previous national experience (P for trend, < 0.0001). Clopidogrel was the most commonly used ADPri (82.2%), with lower use of the newer agents ticagrelor (9.0%) and prasugrel (3.1%). Ticagrelor and prasugrel use was most frequent in patients with STEMI undergoing percutaneous coronary intervention PCI (34.3%). There was relatively lower use of ADPri therapy at discharge; it was given mainly to patients who did not undergo PCI (68.2%) and to those with non-ST-elevation ACS (82%). When comparing the 2 consecutive phases of data collection in the ACS Reflective, there was an approximate 3- and 2-fold increase in the early and discharge use of the newer ADPri agents, respectively. In conclusion, there has been a temporal increase in ADPri use compared with previous national experience and an increased uptake of newer ADPri agents. Additional work is needed to identify and address barriers limiting optimal implementation of these newer guideline-recommended agents into routine Canadian practice.
authors.affiliation: Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Gandhi
authors.affiliation: Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada.
authors.forename: Brigita
authors.initials: B
authors.lastname: Zile
authors.affiliation: Canadian Heart Research Centre, Toronto, Ontario, Canada.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Tan
authors.affiliation: Canadian Heart Research Centre, Toronto, Ontario, Canada.
authors.forename: Jhansi
authors.initials: J
authors.lastname: Saranu
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Claudia
authors.initials: C
authors.lastname: Bucci
authors.affiliation: Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
authors.affiliation: Saskatoon Health Region, Royal University Hospital, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Robertson
authors.affiliation: London Health Sciences Centre, London, Ontario, Canada.
authors.forename: Mackenzie A
authors.initials: MA
authors.lastname: Quantz
authors.affiliation: Trillium Health Partners, The Credit Valley Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Letovsky
authors.affiliation: Montreal Heart Institute, Université de Montréal, Montréal, Québec, Canada.
authors.forename: Jean-Francois
authors.initials: JF
authors.lastname: Tanguay
authors.affiliation: Institut Universitaire de Cardiologie et de Pneumologie de Québec, Québec City, Québec, Canada.
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Dery
authors.affiliation: Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Fitchett
authors.affiliation: Schulich Heart Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.
authors.forename: Mina
authors.initials: M
authors.lastname: Madan
authors.affiliation: Southlake Regional Health Centre, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.affiliation: Oakville Hospital, Oakville, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Heffernan
authors.affiliation: Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Madhu K
authors.initials: MK
authors.lastname: Natarajan
authors.affiliation: Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Graham C
authors.initials: GC
authors.lastname: Wong
authors.affiliation: Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Welsh
authors.affiliation: Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada. Electronic address: goodmans@smh.ca.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D054058:Acute Coronary Syndrome / Q000188:drug therapy; D002170:Canada; D004334:Drug Administration Schedule; D004562:Electrocardiography; D005500:Follow-Up Studies; D019983:Guideline Adherence; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors