| 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). | |
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MedLine Citation:
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PMID: 20552592 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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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:
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Type: Journal Article; Multicenter Study |
Journal Detail:
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Title: Clinical cardiology Volume: 33 ISSN: 1932-8737 ISO Abbreviation: Clin Cardiol Publication Date: 2010 Jun |
Date Detail:
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Created Date: 2010-06-21 Completed Date: 2010-10-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 7903272 Medline TA: Clin Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: E40-8 Citation Subset: IM |
Affiliation:
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Chang Gung University College of Medicine, Taiwan. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Coronary Syndrome
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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:
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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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