Pharmacotherapy in acute coronary syndromes
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Pharmacotherapy in acute coronary syndromes. Perspective from first line and regional hospitals in Czech Republic. Petr Jansky. Cardionale , 26.11.2010. Pilot MI registry ( n=3188 ) 6 non PCI hospitals Discharge pharmacotherapy. Svobodová , 2008. CZECH registry. All ACS patients

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Pharmacotherapy in acute coronary syndromes

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Pharmacotherapyin acutecoronarysyndromes

Perspectivefromfirst line andregionalhospitalsin CzechRepublic

Petr Jansky

Cardionale, 26.11.2010


Pilot MI registry (n=3188)6 non PCI hospitalsDischargepharmacotherapy

Svobodová, 2008


CZECH registry

All ACS patients

11/2005

N 1921

1/ all PCI hospitals (80%)

2/ allcommunityhospitals

in tworegions (20%)

Widimský P. etal., IntJ Cardiol, 2007


Dischargepharmacotherapy STEMI

%

Mandelzweig, EHJ, 2006

Widimský, Int J Cardiol, 2007


DischargepharmacotherapynonSTE ACS

%

Widimský, Int J Cardiol, 2007


Recommendations for performance measures

  • Development of regional and/or national programmes to systematically measure performance indicators and provide feedback to individual hospitals is strongly encouraged (I-C).

European Heart Journal, July 2007


  • Confirmedacutecoronarysyndromes

    (STEMI, NONSTEMI, unstableAP)

  • Continuallysince 1.7.2008

  • 32 non cathhospitals


Qualityofpharmacotherapy

  • Prehospitalphase

  • Earlyhospitalphase

  • On discharge


Patientcharacteristics 7/2008-3/2010


Prehospitalpharmacotherapy


PrehospitalpharmacotherapyEMS vsphysician


Prehospitalpharmacotherapy


Evidence-based medical therapy (heparin, ASA, BB, statin, thienopyridin) within the first 24 hours after admissionis associated with lower in-hospital mortality in NSTEMI

%

N 1889, p < 0,001

Monhartetal., ESC 2008


Pharmacotherapywithin 24 hoursafteradmission

Aspirin

Lineartrend:n.s.


Pharmacotherapywithin24 hoursafteradmission

Betablockers

Lineartrend:n.s.


Pharmacotherapywithin 24 hoursafteradmission

Clopidogrel

Lineartrend:p=0,023


Pharmacotherapywithin24 hoursafteradmission

Statin

Linear trend:p<0,001


Pharmacotherapywithin24 hoursafteradmission

LMWH

Lineartrend:n.s.


Pharmacotherapywithin24 hoursafteradmission

Heparin

Lineartrend:p=0,036


Pharmacotherapywithin24 hoursafteradmission

Fondaparinux

Lineartrend:p=0,011


Pharmacotherapywithin24 hoursafteradmission

* p<0,05; ** p<0,01; *** p<0,001


Dischargepharmacotherapy

Aspirin

Lineartrend:n.s.


Dischargepharmacotherapy

Clopidogrel

Lineartrend:n.s.


Clopidogrelon discharge – individualhospitals


Dischargepharmacotherapy

Betablockers

Lineartrend:n.s.


Betablockers on discharge – individualhospitals


Dischargepharmacotherapy

ACEI

Lineartrend:p=0,012


Dischargepharmacotherapy

Statin

Lineartrend:p<0,001


Dischargepharmacotherapy

Combination(aspirin, clopidogrel, BB, ACEI, statin)

Lineartrend:p=0,010


Dischargepharmacotherapy

* p<0,05; ** p<0,01; *** p<0,001


Conclusion

  • Unsatisfactoryprehospitalpharmacotherapy

  • In-hospitalpharmacotherapyisrelativelygood

    (exc. elderly, females, NONSTEMI)

  • Interhospital variability in thequalityof care

  • Improvement in somerecommendedtherapies(statins, clopidogrelin theacutephase) overshorttime period


Thankyouforyourattention !


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