Abstract 13183: Predictors of Receiving Optimal In-Hospital and Discharge Medical Therapy in ACS in India: Results from the Kerala ACS Registry

Abstract

Introduction: Quality improvement studies have demonstrated stepwise improvements in outcomes with increases in optimal, or guideline-based, ACS care. We sought to understand the prevalence and predictors of optimal in-hospital and discharge medical therapy in the Kerala ACS Registry of 25,718 admissions as part of an ongoing ACS quality improvement initiative.

Methods: We defined optimal in-hospital ACS medical therapy as receiving aspirin, clopidogrel, heparin, beta-blocker, and statin. We defined optimal discharge ACS medical therapy as receiving all of the above except heparin. We evaluated the association between GRACE risk score variables and optimal in-hospital or discharge medical therapy through logistic regression.

Results: Optimal in-hospital and discharge medical therapy was given to 40% and 46% of eligible patients, respectively (Table 1). Patients who received optimal in-hospital care were less likely to present with STEMI (36% vs. 42%), prior MI, (12% vs. 16%) and Killip class >1 (19% vs. 24%; p<0.001 for all). Patients who received optimal in-hospital medical therapy had lower unadjusted in-hospital mortality (3.6% vs. 4.1%, p=0.03) and major adverse cardiovascular event rates (4.0% vs. 4.9%, p=0.001). After adjustment, patients with Killip class >1 (OR [95%CI]=0.56 [0.50, 0.63]) and STEMI versus unstable angina (OR = 0.51 [0.42, 0.62]) were less likely to receive optimal in-hospital care. Patients with Killip class >1 (OR=0.58 [0.52, 0.64]) were less likely to receive optimal discharge care. Individuals who received optimal in-hospital care were ten-fold more likely to receive optimal discharge care (OR=10.5 [9.4, 11.7]).

Conclusions: Gaps are present in in-hospital and discharge medical therapy for ACS in Kerala. Individuals at higher risk are less likely to receive optimal medical therapy. In-hospital medical therapy is a powerful predictor of discharge medical therapy and provides an important target for quality improvement.