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Current discharge management of acute coronary syndromes: data from the Rijnmond Collective Cardiology Research (CCR) study
Authors:T. Yetgin  M. M. J. M. van der Linden  A. G. de Vries  P. C. Smits  R. van Mechelen  S. C. Yap  E. Boersma  F. Zijlstra  R.-J. M. van Geuns
Affiliation:1. Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ee-2355, Dr. Molewaterplein 50-60, 3015 GE, Rotterdam, The Netherlands
2. Department of Cardiology, Vlietland Hospital, Vlietlandplein 2, 3118 JH, Schiedam, The Netherlands
3. Department of Cardiology, Albert Schweitzer Hospital, Albert Schweitzerplaats 25, 3318 AT, Dordrecht, The Netherlands
4. Department of Cardiology, Maasstad Hospital, Maasstadweg 21, 3079 DZ, Rotterdam, The Netherlands
5. Department of Cardiology, Sint Franciscus Gasthuis, Kleiweg 500, 3045 PM, Rotterdam, The Netherlands
6. Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ba-316, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
7. Department of Cardiology, Erasmus MC, Thoraxcentre, Room Bd-381, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
9. Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ba-593, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
8. Department of Cardiology, Erasmus MC, Thoraxcentre, Room Ba-585, ‘s-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
Abstract:

Background

Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge.

Methods

The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guideline-recommended pharmacotherapy at hospital discharge.

Results

At discharge, 94 % of patients received aspirin, 100 % thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % β-blockers, 96 % statins, and 65 % the combination of all 5 agents. ST-segment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age.

Conclusion

Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation.
Keywords:Acute coronary syndrome   Percutaneous coronary intervention   Post-discharge medication
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