Abstract 11996: Exposure to Evidence-Based Secondary Prevention After Acute Coronary Syndrome (ACS) in Australia and New Zealand
Background: Narrowing the known treatment gap in proven secondary prevention measures after ACS will reduce the rate of out-of-hospital coronary death and re-infarction. We report on the application of international evidence-based recommendations for the non-acute management of ACS in Australia and New Zealand.
Methods: All patients hospitalized in Australia and New Zealand and with a discharge diagnosis of confirmed ACS were identified between 14-27 May 2012. Primary outcome was the proportion who received optimal preventive care which was defined as having received lifestyle advice in-hospital (exercise or diet advice and quit advice for smokers), referral to rehabilitation and prescription of at least four of the five major preventive pharmacotherapies (lipid-lowering, aspirin, antiplatelet, beta-blocker, angiotension receptor agent or ace inhibitor).
Results: For the 2,299 patients who survived their index ACS admission, the mean (SD) age was 68 (13) years and 35% were female, 48% had prior vascular disease and 35% prior coronary revascularization. In total, 46% (1065/2299) were referred to an outpatient cardiac rehabilitation program, 36% (831/2299) received dietary advice, 43% (975/2254) received physical activity advice, 65% (1490/2299) were discharge on 4 or more preventive medications and 69% (301/433) of smokers received inpatient smoking cessation advice. In total, 588/2299 (26%) of ACS patients received optimal preventive care at discharge and this was highest for ST segment elevation myocardial infarction (STEMI) (190/390, 49%) and significantly lower for non-STEMI (291/981, 30%, p≤0.001) and unstable angina (107/928, 15%, p≤0.001).
Conclusions: Less than one-third ofall patients admitted with ACS received optimal secondary prevention (pharmacotherapy, lifestyle advice and referral to rehabilitation). Proportionately more STEMI than non-STEMI and unstable angina patients patients received guideline recommended preventive care. These findings highlight the persistence of the evidence treatment gaps in a contemporary cohort of ACS patients.
- © 2013 by American Heart Association, Inc.