Optimale medikamentöse Therapie bei Patienten nach akutem Koronarsyndrom

2018 ◽  
Vol 143 (09) ◽  
pp. 672-679
Author(s):  
Barbara Stähli ◽  
Ulf Landmesser
Keyword(s):  
Blood Pressure ◽  
Acute Coronary Syndrome ◽  
Preventive Measures ◽  
Coronary Revascularization ◽  
Pressure Control ◽  
Lifestyle Changes ◽  
Lipid Lowering ◽  
Current Guideline ◽  
Coronary Syndrome ◽  
European Society Of Cardiology

AbstractAntithrombotic therapy and other secondary preventive measures such as lifestyle changes, lipid lowering and blood pressure control, along with coronary revascularization strategies, can markedly improve clinical outcomes in patients after an acute coronary syndrome. Current guideline-recommended secondary preventive measures in patients with a recent acute coronary syndrome event according to the European Society of Cardiology (ESC) are summarized in this review.

scholarly journals Heart Stroke Plus: Analysis of quality indicators to create an improved pathway for patients following an acute coronary syndrome

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
L Perez De Isla ◽  
JC Gomez Polo ◽  
A Salinas Gallegos ◽  
P Mahia Casado ◽  
A Viana Tejedor ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Acute Coronary Syndrome ◽  
Quality Indicators ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Blood Analysis ◽  
Lipid Lowering ◽  
Care Hospital ◽  
Post Discharge ◽  
Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Sanofi Aventis S.A. Introduction Optimisation of the care of patients after an acute coronary syndrome (ACS) is a fundamental step to improve health outcomes and avoid consecutive cardiovascular events however data on how care is provided is often absent. Purpose Our objective was to analyse the main quality indicators in the post-ACS patient pathway so as to determine the actions which avoid future CDV events. Methods In a random sample of 100 patients between January 2018 and December 2019, we selected the indicators which most affect secondary prevention in patients post-ACS. All patients had been diagnosed with ACS within a tertiary-care hospital with a 24h interventional cardiology lab.  The indicators were retrospectively analysed using the patients’ health record. Results The main results are presented in Table 1. Conclusions Based on this, we proposed an integrated protocol for all patients post-ACS which will begin in 2021 within this tertiary-care hospital. Within this protocol, the information contained in the discharge report will be improved and automatized as much as possible so as re-evaluate at a later date. Table 1: Demographics and results Title of the indicator Yes (%) No (%) Men 76 24 STEMI 40 60 NSTEMI 60 40 Dual antiplatelet therapy included in discharge report 100 0 High doses statins at discharge 98 2 BMI included in discharge report 0 100 LDL objective included in discharge report 14 86 HbA1c objective included in discharge report 13 87 Physical activity included in discharge report 15 85 Flu vaccination recomendations included in discharge report 0 100 Complete blood analysis completed 4-6 weeks after discharge 100 0 Blood pressure is measured on first post-discharge consultation 100 0 Blood pressure medication is changed on first post-discharge consultation 28 78 Patient arrives with measurement for HbA1c on first post-discharge consultation 78 22 Antidiabetic medication is modified on first post-discharge consultation 8 92 BMI is registered on first post-discharge consultation 0 100 Patients with LDL below 55mg/dl on first post-discharge consultation 29 71 Lipid-lowering medications is changed on first post-discharge consultation 29 71

scholarly journals An innovative lipid-lowering approach to enhance attainment of low-density lipoprotein cholesterol goals

2020 ◽  
Vol 9 (8) ◽  
pp. 879-887
Author(s):  
Camille Buonvino ◽  
Romain Chopard ◽  
Benoît Guillon ◽  
Etienne Puymirat ◽  
Michel Farnier ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Therapeutic Goals ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Pretreated Patients ◽  
European Society Of Cardiology

Aims To improve attainment of LDL-cholesterol (LDL-c) targets, an expert group proposed an algorithm for lipid-lowering therapy during hospitalization for acute coronary syndrome and during follow-up. We aimed to assess adherence to this algorithm, and evaluate its impact on LDL-c levels and on attainment of therapeutic LDL-c targets in a population of post-acute coronary syndrome patients. Methods and results Prospective, observational study including patients admitted for acute coronary syndrome between February 2017 and September 2018. Patients admitted without statins or ezetimibe were considered ‘naïve’. Baseline LDL-c was admission LDL-c in naïve patients, and for those taking lipid-lowering therapy at admission, baseline LDL-c was back-calculated. In line with the most recent guidelines, the target was a >50% reduction in naïve LDL-c and <55 mg/dL. In total, 270 patients were analysed, mean age 67 ± 12 years, 78% men, 26% diabetic. At admission, 175 (65%) were naïve, 95 (35%) had previous lipid-lowering therapy, of which 13 (5%) statin+ezetimibe. Average LDL-c at admission was 120 ± 47 mg/dL (136 ± 44 mg/dL in naïve, 91 ± 39 mg/dL in pretreated patients). Discharge prescription was in compliance with the algorithm in 204 (76%) patients. Average LDL-c at two months was 57 ± 28 mg/dL; it was <55 mg/dL in 135 (50%), and 178 (66%) achieved a >50% reduction. Overall, 125/270 (46%) achieved the LDL-c goal. The reduction in LDL-c observed at two months persisted at five months. Conclusion Prescription of high-intensity statins, associated with ezetimibe where applicable, achieves LDL-c levels <55 mg/dL in 50% of patients at two months, and attains therapeutic goals defined by the European Society of Cardiology in 46% of cases.

A consensus statement on lipid management after acute coronary syndrome

2016 ◽  
Vol 7 (6) ◽  
pp. 532-543 ◽  
Author(s):  
François Schiele ◽  
Michel Farnier ◽  
Michel Krempf ◽  
Eric Bruckert ◽  
Jean Ferrières ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lipid Management ◽  
Coronary Syndrome ◽  
Dose Adaptation ◽  
Lowering Therapy ◽  
European Society Of Cardiology

In patients admitted for acute coronary syndrome (ACS), the guidelines of the European Society of Cardiology give a Class I, Level A recommendation for the prescription of high-intensity statins to be initiated as early as possible, regardless of the low-density lipoprotein cholesterol (LDL-C) level. Although statins are widely prescribed after ACS, the intensity of therapy and the proportion of patients achieving target LDL-C values are often not in line with recommendations due to a lack of compliance with guidelines by the physicians, a lack of compliance with treatment or poor tolerance by patients, and poor dose adaptation. In this context, a group of French physicians came together to define strategies to facilitate and improve the management of lipid-lowering therapy after ACS. This paper outlines the scientific rationale for the use of statins at the acute phase of ACS, the utility of ezetimibe, the measurement of LDL-C during the course of ACS, the opportunities for detecting familial hypercholesterolaemia and the results of the consensus for the management of lipid-lowering therapy, illustrated in two decision-making algorithms.

Abstract 378: Using Lean Methodology to Reduce Variation in Care of Acute Coronary Syndrome Patients

2015 ◽  
Vol 8 (suppl_2) ◽  
Author(s):  
Guy Fradet ◽  
Carol Laberge ◽  
Andrew Kmetic ◽  
Ronnalea Hamman
Keyword(s):  
Decision Making ◽  
Acute Coronary Syndrome ◽  
Regional Variation ◽  
Coronary Revascularization ◽  
Patient Characteristics ◽  
Care Utilization ◽  
Process Of Care ◽  
Patient Journey ◽  
Coronary Syndrome ◽  
Decision Points

Background: Regional variation in the utilization of health services is a well-documented phenomenon in health care with numerous studies reporting substantial and unexplained variations in coronary revascularization. In the Canadian province of British Columbia (BC), five cardiac centers provide coronary revascularization services. In 2011 Cardiac Services BC (CSBC) undertook a study that identified substantial regional variation in coronary revascularization that could not be explained by patient characteristics or risk factors. Following this initial project, CSBC launched an initiative to help better understand the regional variations and possibly devise and implement strategies to reduce them. To get a better understanding of the different processes of care/utilization, one of the approaches used is the application of Lean methodology to the care of acute coronary syndrome (ACS) patients. Methods: Lean methodology is being applied to the patient journey of ACS patients. At each revascularization center Value Steam Maps process maps (VSM) are being prepared through a series of meetings with support, frontline, administrative and clinical staff (see attached example). For each VSM the goal is to identify key decision points in the process of care for ACS patients and to drill down on (Root Cause Analysis) on the decision making environment and criteria used to determine the utilization of coronary revascularization services. Once VSM have been completed they will be compared across sites for similarities and differences. The differences in decision making will then be assessed to determine their effect on variation in utilization across the centers. Discussion: BC is attempting to reduce unexplained variation in coronary revascularization using the Lean methodology to take a systematic approach to the analysis of the process of ACS care across the province. The next step will be to determine to what extent it is possible to standardize decision making at the key decision points across the HAs. Standardization will be achieved through a mix of best practices, evidence and application of guidelines. While the undertaking is still in the early stages it is expected that it will lead to, at the very least, ACS patients receiving the same care regardless of where they receive their care in BC.

Coronary revascularization in acute coronary syndrome: does the choice of the conduit matter?

2021 ◽  
Author(s):  
Jasmin. H. SHAHINIAN ◽  
Mertan GÜRLEYEN ◽  
Marlon GRODD ◽  
Martin WOLKEWITZ ◽  
Friedhelm BEYERSDORF ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Revascularization ◽  
Coronary Syndrome

scholarly journals Lipid Lowering Treatment and Follow Up in Recent Post Acute Coronary Syndrome Patients: Real-World Evidence from the Multicenter Observational Prospective - Post Acute Coronary Syndrome Italian Study (PACSI)

2020 ◽  
Vol 19 ◽  
Author(s):  
Pompilio Faggiano ◽  
Giuseppe Patti ◽  
Stefania Cercone ◽  
Laura Canullo ◽  
Roberta Rossini ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Recurrent Events ◽  
Real Life ◽  
Lipid Lowering ◽  
Pharmacological Intervention ◽  
Adherence Rate ◽  
Prospective Clinical Study ◽  
Target Attainment ◽  
Coronary Syndrome

PURPOSE: Patients suffering from an acute coronary syndrome are at very high risk for recurrent events. Early targeted pharmacological intervention primarily aimed at controlling plasma LDL-cholesterol (LDL-C) levels can result in the reduction of recurrent cardiovascular events. This study aimed to evaluate real-life evidence from the Italian setting to document current practice of secondary prevention in patients after acute coronary syndrome (ACS), specifically assessing: (i) the rate of LDL-C target (<70 mg/dl) achievement after 6-10 weeks from index event and at later follow-up, (ii) the distance from LDL-C target during follow up, (iii) adherence rate and visit attendance. METHODS Multicenter observational prospective clinical study ACS patients, evaluating target attainment rate at 6 weeks (V0) and 18 months (V2). RESULTS Approximately 97.4% patients enrolled (N=524) received statin-based therapy, and 3.6% received ezetimibe at discharge; mean LDL-C values decreased from 113.0±44.7 mg/dL at discharge to 71.3±26.5 mg/dl at V0. Among patients with known LDL-C for main time-points, 51.7% achieved target LDL-C at V0, 45.8% at V2. Among patients not reaching the target, the mean distance from target was 23.5±20.7 mg/dL. Attainment of target LDL-C was similar in patients receiving intensive or low-moderate statin-based treatment (approximately 50%). LDL-C target attainment was associated with lower LDL-C value at discharge and smoking status. Adherence to statin treatment was high (96.2%) throughout, similarly to medical appointment attendance at V2 (84.7%). CONCLUSION Despite most ACS patients receiving intensive statin-based regimens, only approximately half achieved LDL-C target, suggesting the need for further optimizing drug selection, combination and dosage. 

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