Outcomes of Secondary Prevention Medications in Patients with Non–ST-Elevation Acute Coronary Syndrome at One year after Hospital Discharge

Abstract

Objective: To evaluate the outcomes of evidence-based medications used for secondary prevention in patients with NSTE-ACS (non-ST-elevation acute coronary syndrome) at one year after hospital discharge. Method: This research was a retrospective analytical cohort study. The data from medical records in electronic databases of two hospitals was collected from October 2015 to September 2018. Recruitment criteria were patients who were diagnosed with NSTE-ACS, aged 18 years and over, and hospitalized and discharged with surviving status. The data on the prescribing of four medications for secondary prevention including dual anti-platelets, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), and angiotensin receptor blockers (ARBs), statins was collected. The study outcome of post-discharge adverse events (AEs) at 1-year follow-up was collected. The AEs incidence was analyzed compared between the group received four medications and the group received less than four medications by using a Cox-proportional hazard regression analysis adjusted with propensity score. Results: Of the 334 patients in the study, 44 received four medications for secondary prevention (13.17%) and 290 patients receive less than four medications for secondary prevention (86.83%). The incidence of AEs at one year in those receiving four medications decreased by 6% when compared  with those received less than four medications (adjusted HR 0.94, 95%CI 0.56-1.57; P=0.814). The rates of prescribing four medications significantly increased at 6 and 12 months of follow-up when compared with the day of hospital discharge (13.17% vs. 27.98%; P<0.001, 13.17% vs. 27.49%; P<0.001, respectively). Co-morbidities including congestive heart failure (adjusted OR 0.30, 95%CI 0.12-0.77; P= 0.012) and chronic kidney disease (adjusted OR 0.25, 95%CI 0.09-0.67; P=0.006) were significantly associated with less incidence in the group received four medications. Hospital where patients received treatment was a significant factor associated with an increase in prescribing of four medications (adjusted OR 7.82, 95%CI 2.04-29.4; P=0.003). Conclusion: The patients with NSTE-ACS received four medications for secondary prevention significantly more at 1-year follow-up period. The hospital was a significant factor associated with an increase in the prescribing of four medications for secondary prevention. Congestive heart failure and chronic renal disease were significantly associated with less incidence in patients received four medications.