title: Interhospital Variability in Drug Prescription After Acute Coronary Syndrome: Insights From the ACDC Study.
abstract: OBJECTIVE
  To analyze the rate of patients admitted for acute coronary syndrome who concomitantly received acetylsalicylic acid, statins, and angiotensin-converting enzyme inhibitors at discharge, and to analyze interhospital variability in the prescription of these drugs and its potential prognostic impact.
  
  
  METHODS
  Interhospital variability in drug prescription was estimated using the intraclass correlation coefficient and median odds ratio (hierarchical analysis). Cox regression analysis was used to estimate the risk of death or myocardial infarction associated with prescription of all 3 agents at 2-years of follow-up.
  
  
  RESULTS
  In total, 489 (53.3%) of 917 patients were prescribed all 3 agents. The rate was similar in patients with hypertension and diabetes (56.8%). There was significant variability among centers in the prescription of the 3 drugs at discharge (from 23% to 77% of patients). Hypertension (odds ratio=1.93; 95% confidence interval, 1.42-2.61), ejection fraction < 45% (odds ratio=2.2; 95% confidence interval, 1.44-3.37), being in a clinical trial (odds ratio=1.89; 95% confidence interval, 1.24-2.88), and renal failure (odds ratio=0.53; 95% confidence interval, 0.29-0.94) were associated with prescription of the 3 drugs. After adjustment for these factors, residual variability persisted (intraclass correlation coefficient 0.046 [95% credibility interval, 0.007 to 0.192]; median odds ratio=1.46 [95% credibility interval, 1.16-2.32]). There was no clear association between the prescription of all 3 drugs and the risk of events during follow-up (hazard ratio=0.81, 95% confidence interval, 0.55-1.18; P=.27).
  
  
  CONCLUSIONS
  The prescription rate for acetylsalicylic acid, angiotensin-converting enzyme inhibitors, and statins after acute coronary syndrome is suboptimal, varies among centers, and is possibly related to different health care approaches.
authors.affiliation: Unidad de Epidemiología, Servicio de Cardiología, Hospital Universitari Vall d'Hebron, CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. Electronic address: nacho@ferreiragonzalez.com.
authors.forename: Ignacio
authors.initials: I
authors.lastname: Ferreira-González
authors.affiliation: Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain.
authors.forename: Xavier
authors.initials: X
authors.lastname: Carrillo
authors.affiliation: Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Martín
authors.affiliation: Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: de la Torre Hernández
authors.affiliation: Servicio de Cardiología, Hospital Meixoeiro, Vigo, Pontevedra, Spain.
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Baz
authors.affiliation: Servicio de Cardiología, Hospital Universitari i Politècnic La Fe, Valencia, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Navarro Manchón
authors.affiliation: Servicio de Cardiología, Hospital Clínic i Provincial de Barcelona, Barcelona, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Masotti
authors.affiliation: Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Ángel
authors.initials: Á
authors.lastname: Cequier
authors.affiliation: Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain.
authors.forename: Mérida
authors.initials: M
authors.lastname: Cárdenas
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario San Carlos, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Alfonso Manterola
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy* / Q000401:mortality; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use*; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D016896:Treatment Outcome
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin
keywords: Acute coronary syndrome; Policomprimido; Polypill; Síndrome coronario agudo; Variabilidad de prescripción; Variability in prescribing