Trends in pharmacological therapy following an acute coronary syndrome in Portugal: a systematic review.
OBJECTIVE
To assess time trends in the use of main drug classes for secondary prevention, during hospitalization and at hospital discharge, following an acute coronary syndrome, in Portugal, using a systematic review.


METHODS
We searched PubMed, from inception until 2012, to identify studies reporting the proportion of acute coronary syndrome patients treated with main pharmacological therapy. We used linear regression to quantify the annual variation in use of drugs, adjusting for the proportion of men in the sample and patients' mean age, and including a quadratic term of data collection year when relevant.


RESULTS
In 25 eligible studies, including patients treated from 1993 to 2009, we observed an increase in the prescription of pharmacological treatments at hospital discharge. Extrapolating from these data, and assuming a mean patient age of 65 years and 70% of men, we estimate that in 2008, 95% of patients would have been discharged with aspirin, 92% with clopidogrel, 82% with β-blockers, 80% with angiotensin-converting enzyme inhibitors and 91% with statins. Treatment during hospitalization followed a similar pattern, except for a steeper increase in angiotensin-converting enzyme inhibitors use, which was initially lower, but reached similar levels to those at discharge in recent years.


CONCLUSIONS
In Portugal, there was an increase in the use of recommended pharmacological therapy for secondary prevention after an acute coronary syndrome over the last 15 years, during hospitalization and at hospital discharge.
aDepartment of Clinical Epidemiology, Predictive Medicine and Public Health, University of Porto Medical School and Institute of Public Health of the University of Porto (ISPUP), Porto, Portugal bDepartment of Pharmacology and Therapeutics, Trinity Centre for Health Sciences; St James's Hospital, Dublin, Ireland cDepartment of Cardiology, Centro Hospitalar de São João, EPE, Porto, Portugal.
Marta
M
Pereira
Luisa
L
Lopes-Conceição
Kathleen
K
Bennett
Paula
P
Dias
Olga
O
Laszczynska
Nuno
N
Lunet
Ana
A
Azevedo
D054058:Acute Coronary Syndrome / Q000517:prevention & control*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D000077144:Clopidogrel; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D055502:Secondary Prevention / Q000379:methods*; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use
D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin