Document Detail


The causes and outcomes of inadequate implementation of existing guidelines for antiplatelet treatment in patients with acute coronary syndrome: the experience from Taiwan Acute Coronary Syndrome Descriptive Registry (T-ACCORD Registry).
MedLine Citation:
PMID:  20552592     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Benefits of antiplatelet agents in preventing future cardiovascular events have been well established. However, the prescription pattern of antiplatelet usage in patients with acute coronary syndrome (ACS) is rarely investigated. Hence, Taiwan ACute CORonary Syndrome Descriptive Registry (T-ACCORD Registry) aimed to evaluate medical practices in Taiwan in managing ACS patients. HYPOTHESIS: The guidelines of antiplatelet treatment is not properly implanted in the management of ACS patients. METHODS: This prospective observational study was performed between April 2004 and December 2006 in 27 hospitals in Taiwan. A total of 1331 patients with unstable angina or non-ST-elevation myocardial infarction (NSTEMI) discharged from hospitals was analyzed. RESULTS: The patients with older age, lower hemoglobin levels, or previous cardiovascular ischemic diseases were less likely to receive aspirin at discharge, whereas patients with NSTEMI were less likely to receive clopidogrel at discharge. The prescription of dual antiplatelet agents declined rapidly from 61.8% at discharge to 12.6% at 12 months. The most common reason for clopidogrel discontinuation was recorded as physician's judgment. Dual antiplatelet treatment for 9 months or longer was associated with lower 1-year mortality. Percutaneous coronary intervention (PCI) was the only factor leading to dual antiplatelet therapy for at least 9 months. CONCLUSIONS: Our registry showed that underlying medical conditions may affect antiplatelet prescriptions at discharge. During the first year following an ACS episode, the prescription rate of dual antiplatelet therapy declined over time, mainly due to physician's judgment leading to the discontinuation of clopidogrel. Adherence to dual antiplatelet treatment was associated with lower total mortality at 1 year.
Authors:
Cheng-I Cheng; Ching-Pei Chen; Pei-Liang Kuan; Meng-Huan Lei; Chiau-Suong Liau; Kwo-Chang Ueng; Chiung-Jen Wu; Wen-Ter Lai
Publication Detail:
Type:  Journal Article; Multicenter Study    
Journal Detail:
Title:  Clinical cardiology     Volume:  33     ISSN:  1932-8737     ISO Abbreviation:  Clin Cardiol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-21     Completed Date:  2010-10-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E40-8     Citation Subset:  IM    
Affiliation:
Chang Gung University College of Medicine, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy*,  mortality
Aged
Aged, 80 and over
Aspirin / administration & dosage*
Chi-Square Distribution
Drug Administration Schedule
Drug Prescriptions
Drug Therapy, Combination
Drug Utilization
Female
Guideline Adherence
Hospitals
Humans
Kaplan-Meiers Estimate
Male
Middle Aged
Odds Ratio
Outcome and Process Assessment (Health Care)* / statistics & numerical data
Patient Discharge
Physician's Practice Patterns* / statistics & numerical data
Platelet Aggregation Inhibitors / administration & dosage*
Practice Guidelines as Topic
Prospective Studies
Registries
Risk Assessment
Risk Factors
Taiwan / epidemiology
Ticlopidine / administration & dosage,  analogs & derivatives*
Time Factors
Treatment Outcome
Chemical
Reg. No./Substance:
0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin; 55142-85-3/Ticlopidine; 90055-48-4/clopidogrel

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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