title: Use of cardiovascular prevention treatments after acute coronary syndrome in China and associated factors.
abstract: BACKGROUND
  Prevention of repeat cardiovascular events is an important means of addressing the increasing burden of coronary heart disease in China, however there is minimal information about the use of cardiovascular prevention treatment following acute coronary syndrome (ACS) in China.
  
  
  METHODS
  We analysed data from baseline and 6, 12, 18, and 24-month follow-up surveys of 15,140 consecutive ACS patients recruited in 70 hospitals from 17 provinces of China. We describe the use of indicated cardiovascular prevention medicines, risk factor control, change over time and factors associated with continued prevention.
  
  
  RESULTS
  12,094 patients had follow-up data up to 12months. At discharge, 86.1% were on a combination of antiplatelet, statin and blood pressure (BP) lowering drugs. Use of this combination fell to 68.0% at 12months and 59.7% in patients followed to 24months. Patients admitted to tertiary hospitals were more likely to be on the combination compared to secondary hospitals (at discharge 90.1% vs. 79.5%, p<0.0001; at 12months 71% vs. 64%, p<0.001 respectively). At 12months 25.2% achieved control in ≥four of five guideline levels of risk factors and this was similar by hospital level. Prescription of BP-lowering drugs and statins at discharge was the strongest predictor of use at 12months follow-up. Lower income was associated with less use of both.
  
  
  CONCLUSIONS
  Use of cardiovascular prevention treatment declines steadily over time following an ACS. The largest proportional decline is in the first six months. Ensuring patients are discharged on these therapies and addressing barriers for low-income earners may help address this gap.
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia. Electronic address: eatkins@georgeinstitute.org.au.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Atkins
authors.affiliation: The George Institute for Global Health, Beijing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Du
authors.affiliation: The George Institute for Global Health, Beijing, China; Department of Epidemiology and Biostatistics, Peking University School of Public Health, China; China International Center for Chronic Disease Prevention, China.
authors.forename: Yangfeng
authors.initials: Y
authors.lastname: Wu
authors.affiliation: Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, China.
authors.forename: Runlin
authors.initials: R
authors.lastname: Gao
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Royal Prince Alfred Hospital, Australia.
authors.forename: Anushka
authors.initials: A
authors.lastname: Patel
authors.affiliation: The George Institute for Global Health, University of Sydney, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Westmead Hospital, Australia.
authors.forename: Clara K
authors.initials: CK
authors.lastname: Chow
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002681:China / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods* / Q000639:trends; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
chemical_list: D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Acute coronary syndromes; Adherence; Cardiovascular prevention treatment; Risk factors; Women