Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq

Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whe...

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Main Authors: Nassr OA, Forsyth P, Johnson CF
Format: Article
Language:English
Published: Centro de Investigaciones y Publicaciones Farmaceuticas 2019-03-01
Series:Pharmacy Practice
Subjects:
Online Access:https://www.pharmacypractice.org/journal/index.php/pp/article/view/1372
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spelling doaj-5f917a1bf03b4afb8267107b1f025e392020-11-25T03:46:26ZengCentro de Investigaciones y Publicaciones FarmaceuticasPharmacy Practice1885-642X1886-36552019-03-01171137210.18549/PharmPract.2019.1.1372Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in IraqNassr OAForsyth PJohnson CFBackground: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Methods: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50–74%, and low dosing as <50% of the target dose. Results: 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days). In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively. Conclusions: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team.https://www.pharmacypractice.org/journal/index.php/pp/article/view/1372Acute Coronary SyndromeProfessional PracticeGuideline AdherenceDrug UtilizationAngiotensin-Converting Enzyme InhibitorsAngiotensin Receptor AntagonistsClinical AuditIraq
collection DOAJ
language English
format Article
sources DOAJ
author Nassr OA
Forsyth P
Johnson CF
spellingShingle Nassr OA
Forsyth P
Johnson CF
Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq
Pharmacy Practice
Acute Coronary Syndrome
Professional Practice
Guideline Adherence
Drug Utilization
Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Antagonists
Clinical Audit
Iraq
author_facet Nassr OA
Forsyth P
Johnson CF
author_sort Nassr OA
title Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq
title_short Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq
title_full Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq
title_fullStr Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq
title_full_unstemmed Evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in Iraq
title_sort evaluation of discharge prescriptions for secondary prevention in patients with acute coronary syndromes in iraq
publisher Centro de Investigaciones y Publicaciones Farmaceuticas
series Pharmacy Practice
issn 1885-642X
1886-3655
publishDate 2019-03-01
description Background: Optimal prescribing of secondary prevention medications after acute coronary syndrome (ACS) events has been shown to reduce morbidity and mortality. However, it is unknown whether these medications are optimally prescribed at discharge from acute care in Iraq. Objective: To evaluate whether patients with ACS received optimal secondary prevention medications: antiplatelets, statins, angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACEI/ARBs), and beta-blockers at discharge from a cardiology unit, and to assess whether statins, ACEI/ARBs and beta-blockers were prescribed at target doses based on the American Heart Association/American College of Cardiology (AHA/ACC) guidelines. Methods: Observational retrospective cross-sectional study of patients with ACS admitted to a hospital in Baghdad and survived to discharge between May 2016 and January 2017. Patient-level data and secondary prevention medications at discharge were extracted from routine medical records. Optimal dosing was defined as ≥75%, moderate dosing as 50–74%, and low dosing as <50% of the target dose. Results: 45.6% (200/439) of eligible patients were included in the study who were aged 25 to 90 years (mean 57.8 years) with 78.0% (156/200) being male. Of those included, 84.5% had a myocardial infarction and 15.5% unstable angina, and the length of hospital stay ranged from 1 to 29 days (median 4 days). In total, 53.5% of patients were prescribed all five secondary prevention medications at discharge, and after accounting for contraindications, 60.0% were treated according to AHA/ACC guidelines. The prescription rate of dual antiplatelet therapy, statins, ACEI/ARBs and beta-blockers was 92.5%, 94.5%, 69.5% and 87.0% respectively. Hypertension, diabetes mellitus and the prescription of oral nitrates were associated with the prescription of optimal secondary prevention therapy. Although 80.9% of patients were prescribed target doses of antiplatelets and statins, only 12.2% and 9.2% were prescribed target doses of ACEI/ARBs, and beta-blockers respectively. Conclusions: Approximately one in two patients received the recommended secondary prevention therapy. However, only a minority of patients were prescribed optimal doses of ACEI/ARBs and beta-blockers, in line with guidance. Quality improvement strategies should be implemented, which may include greater involvement of pharmacists within the cardiology multidisciplinary team.
topic Acute Coronary Syndrome
Professional Practice
Guideline Adherence
Drug Utilization
Angiotensin-Converting Enzyme Inhibitors
Angiotensin Receptor Antagonists
Clinical Audit
Iraq
url https://www.pharmacypractice.org/journal/index.php/pp/article/view/1372
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