Document Detail


Receipt of cardiac medications upon discharge among men and women with acute coronary syndrome and nonobstructive coronary artery disease.
MedLine Citation:
PMID:  20063300     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Management of acute coronary syndrome (ACS) patients with nonobstructive epicardial coronary artery disease (CAD) remains poorly understood.
HYPOTHESIS: Acute coronary syndrome patients with nonobstructive CAD are less likely to receive effective cardiac medications upon discharge from the hospital.
METHODS: We identified patients hospitalized with ACS that underwent coronary angiography and had a 6-month follow-up. Patients were grouped by CAD severity: nonobstructive CAD (<50% blockage in all vessels) or obstructive CAD (> or =50% blockage in > or = 1 vessels). Data were collected on demographics, medications at discharge, and adverse outcomes at 6 months, for all patients.
RESULTS: Of the 2264 ACS patients included in the study: 123 patients had nonobstructive CAD and 2141 had obstructive CAD. Cardiac risk factors including hypertension and diabetes were common among patients with nonobstructive CAD. Men and women with nonobstructive CAD were less likely to receive cardiac medications compared to patients with obstructive CAD including aspirin (87.8% vs 95.0%, P = 0.001), beta-blockers (74.0% vs 89.2%, P < 0.001), or statins (69.1% vs 81.2%, P = 0.001). No gender-related differences in discharge medications were observed for patients with nonobstructive CAD. However, women with nonobstructive CAD had similar rates of cardiac-related rehospitalization as men with obstructive CAD (23.3% and 25.9%, respectively).
CONCLUSIONS: Patients with nonobstructive CAD are less likely to receive evidence-based medications compared to patients with obstructive CAD, despite the presence of CAD risk factors and occurrence of an ACS event. Further research is warranted to determine if receipt of effective cardiac medications among patients with nonobstructive CAD would reduce cardiac-related events.
Authors:
Vijay S Ramanath; David F Armstrong; Mary Grzybowski; Sahand Rahnama-Mohagdam; Umesh U Tamhane; Kelly Gordon; James B Froehlich; Kim A Eagle; Elizabeth A Jackson
Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Clinical cardiology     Volume:  33     ISSN:  1932-8737     ISO Abbreviation:  Clin Cardiol     Publication Date:  2010 Jan 
Date Detail:
Created Date:  2010-01-18     Completed Date:  2011-02-04     Revised Date:  2013-05-31    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  36-41     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Wiley Periodicals, Inc.
Affiliation:
Department of Medicine, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Lebanon, New Hampshire, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / drug therapy*
Adrenergic beta-Antagonists / therapeutic use
Age Factors
Angiotensin-Converting Enzyme Inhibitors / therapeutic use
Anticholesteremic Agents / therapeutic use
Antihypertensive Agents
Aspirin / therapeutic use
Coronary Artery Disease / drug therapy*,  pathology
Evidence-Based Medicine
Female
Health Status Indicators
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
Male
Middle Aged
Multivariate Analysis
Patient Discharge / statistics & numerical data*
Patient Education as Topic / statistics & numerical data*
Pericardium / pathology
Physician's Practice Patterns
Platelet Aggregation Inhibitors / therapeutic use
Prospective Studies
Registries
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
K23 HL073310-01/HL/NHLBI NIH HHS; K23 HL073310-05/HL/NHLBI NIH HHS
Chemical
Reg. No./Substance:
0/Adrenergic beta-Antagonists; 0/Angiotensin-Converting Enzyme Inhibitors; 0/Anticholesteremic Agents; 0/Antihypertensive Agents; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Platelet Aggregation Inhibitors; 50-78-2/Aspirin
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