Coronary artery diseasePredictors of Early Discontinuation of Evidence-Based Medicine After Acute Coronary Syndrome
Section snippets
Methods
MAINTAIN is a longitudinal follow-up study that enrolled high-risk patients with non–ST-segment elevation ACS from United States hospitals included in the CRUSADE quality improvement initiative or ACTION registry from January 2006 to September 2007. The CRUSADE QI initiative, started in November 2001, transitioned to the ACTION registry in January 2007. The ACTION registry is the combination of CRUSADE and the National Registry for Myocardial Infarction (http://www.ncdr.com). Inclusion criteria
Results
Of the 1,077 patients, 1,006 (93.4%) were discharged on aspirin, 816 (75.8%) on clopidogrel, 982 (91.2%) on β blocker, 745 (69.2%) on ACEI/ARB (663, 61.6%, on ACEI and 86, 8.0%, on ARB), and 968 (89.9%) on lipid-lowering medication (942, 87.5%, on statin and 188, 17.5%, on nonstatin). Figure 2 displays—for each class of EBM drug—the proportion of patients who were prescribed that class of drug at discharge and the proportion of those who were still taking or started (new prescription) that
Discussion
Three months after hospital discharge, 28% of patients with ACS had discontinued ≥1 of their prescribed EBM. Although some (38%) discontinued EBM with the advice and input of their providers, most (62%) self-discontinued. Self-discontinuation was associated with lack of prescription drug coverage, a larger number of medications prescribed at discharge, and no medication-reminder tools. In addition, patients on dialysis or with peripheral arterial disease were more likely to self-discontinue
Acknowledgment
We acknowledge Tina Harding and Khaula Baloch for their dedicated efforts to the leadership and co-ordination of the MAINTAIN initiative and the interviewing team (Nancy Clapp-Channing, Andrea Davis, Tatiana Metelova) and the data management team (Marian Jones-Richmond, Bob Sanderford, Allyson Drew, Laura Drew, Abigail Patterson, Jeannie Sands) for their tremendous work. We also express our gratitude and appreciation to the physicians and nurses participating in MAINTAIN.
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Cited by (0)
MAINTAIN is funded by Bristol-Myers Squibb/Sanofi-Aventis Pharmaceuticals partnership and by Merck Schering-Plough Pharmaceutical.