scholarly journals Is the use of two versus one long-acting bronchodilator by patients with COPD associated with a higher risk of acute coronary syndrome in real-world clinical practice?

2021 ◽  
Vol 8 (1) ◽  
pp. e000840
Author(s):  
Lianne Parkin ◽  
Sheila Williams ◽  
David Barson ◽  
Katrina Sharples ◽  
Simon Horsburgh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Real World ◽  
Chronic Obstructive ◽  
Treatment Intensification ◽  
Cardiovascular Comorbidity ◽  
Coronary Syndrome ◽  
Long Acting ◽  
The Impact

BackgroundCardiovascular comorbidity is common among patients with chronic obstructive pulmonary disease (COPD) and there is concern that long-acting bronchodilators (long-acting muscarinic antagonists (LAMAs) and long-acting beta2 agonists (LABAs)) may further increase the risk of acute coronary events. Information about the impact of treatment intensification on acute coronary syndrome (ACS) risk in real-world settings is limited. We undertook a nationwide nested case–control study to estimate the risk of ACS in users of both a LAMA and a LABA relative to users of a LAMA.MethodsWe used routinely collected national health and pharmaceutical dispensing data to establish a cohort of patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 1 February 2006 and 30 December 2013. Fatal and non-fatal ACS events during follow-up were identified using hospital discharge and mortality records. For each case we used risk set sampling to randomly select up to 10 controls, matched by date of birth, sex, date of cohort entry (first LAMA and/or LABA dispensing), and COPD severity.ResultsFrom the cohort (n=83 417), we identified 5399 ACS cases during 281 292 person-years of follow-up. Compared with current use of LAMA therapy, current use of LAMA and LABA dual therapy was associated with a higher risk of ACS (OR 1.28 (95% CI 1.13 to 1.44)). The OR in an analysis restricted to fatal cases was 1.46 (95% CI 1.12 to 1.91).ConclusionIn real-world clinical practice, use of two versus one long-acting bronchodilator by people with COPD is associated with a higher risk of ACS.

scholarly journals 313Long-acting bronchodilators and risk of acute coronary syndrome

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Lianne Parkin ◽  
Sheila Williams ◽  
Katrina Sharples ◽  
David Barson ◽  
Simon Horsburgh ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Conditional Logistic Regression ◽  
Chronic Obstructive ◽  
Study Cohort ◽  
Treatment Intensification ◽  
Cohort Entry ◽  
Coronary Syndrome ◽  
Increased Risk ◽  
Long Acting ◽  
The Impact

Abstract Background There is concern that long-acting bronchodilators (long-acting muscarinic antagonists [LAMAs]) and long-acting beta2-agonists [LABAs]) may further increase the already elevated risk of cardiovascular events in patients with chronic obstructive pulmonary disease (COPD). Guidelines recommend stepwise escalation from one to two long-acting bronchodilators in patients with uncontrolled symptoms, but information about the impact of this treatment intensification on acute coronary syndrome (ACS) risk is limited. Methods We undertook a nested case-control study using national administrative data to estimate the risk of ACS in users of dual LAMA and LABA therapy, and users of LABA monotherapy, relative to users of LAMA monotherapy. The underlying study cohort comprised patients aged >45 years who initiated long-acting bronchodilator therapy for COPD between 2006 and 2013 (n = 83,417). Cases were patients diagnosed with fatal or non-fatal ACS after cohort entry (n = 5,399). Up to 10 controls per case, matched by age, sex, date of cohort entry, and COPD severity, were randomly selected from the study cohort using risk set sampling. Odd ratios and 95% confidence intervals were estimated using conditional logistic regression. Results Relative to current use of LAMA monotherapy, the adjusted odds ratios for current use of dual LAMA and LABA therapy, and of LABA monotherapy, were 1.28 (95% CI 1.13–1.44) and 1.0 (95% CI 0.91–1.10), respectively. Conclusions Use of two long-acting bronchodilators rather than LAMA monotherapy, is associated with a higher risk of ACS, while the risks associated with LAMA and LABA monotherapy are comparable. Key messages The clinical benefit of adding a second long-acting bronchodilator to LAMA or LABA monotherapy is modest and, at the same time, is associated with an increased risk of ACS in a patient group already at high risk.

Improving Adherence to Ticagrelor in Patients After Acute Coronary Syndrome: Results from the PROGRESS Trial

2020 ◽  
Vol 18 (3) ◽  
pp. 294-301 ◽  
Author(s):  
Mario Crisci ◽  
Felice Gragnano ◽  
Marco Di Maio ◽  
Vincenzo Diana ◽  
Elisabetta Moscarella ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Antiplatelet Therapy ◽  
Outpatient Clinic ◽  
Acute Coronary Syndromes ◽  
Dual Antiplatelet Therapy ◽  
Coronary Syndrome ◽  
Coronary Syndromes ◽  
The Impact

Background: Dual antiplatelet therapy (DAPT) with aspirin and ticagrelor is recommended for at least 12 months in patients after an acute coronary syndrome (ACS). However, its underuse and premature discontinuation are common in clinical practice. We aimed to investigate the impact of a dedicated follow-up strategy with clinical visits and counselling on adherence levels to ticagrelor in patients after ACS. Methods: PROGRESS (PROmotinG dual antiplatelet therapy adheREnce in the setting of acute coronary Syndromes) is a prospective, randomized trial enrolling 400 ACS patients treated with ticagrelor. Patients were randomized to be followed-up in a dedicated outpatient clinic (In-person follow-up group, [IN-FU], n=200), or with scheduled for phone interviews only (Telephone follow-up group [TEL-FU], n=200), to assess ticagrelor adherence and related complications. DAPT disruption was defined as an interruption of the administration of the drug due to complications or other reasons of non-adherence, and divided according to the duration into short (1-5 days), temporary (6-30 days) and permanent (≥30 days) disruption. The primary endpoint was the rate of DAPT disruption at 1-year follow-up. Results: The rate of ticagrelor disruption at 1 year follow-up was higher in the TEL-FU group than in the IN-FU group (19.6 vs 5.5%; p<0.0001). The IN-FU group reported a significantly lower rate of short (3.0 vs 8.5%; p=0.012) and permanent (2.0 vs 9.6%; p=0.012) disruption than TEL-FU group. The rate of major bleeding did not differ significantly between the 2 groups (p=0.450). Conclusion: The PROGRESS trial showed a net reduction in DAPT disruption in patients followed-up with clinical (in-person) follow-up visits in a dedicated outpatient clinic compared with those scheduled for phone interviews only.

Assessment of the impact of concomitant chronic obstructive pulmonary disease on the outcomes of acute coronary syndrome

Pharmateca ◽  
2020 ◽  
Vol 14_2020 ◽  
pp. 74-80
Author(s):  
B.G. Iskenderov Iskenderov ◽  
N.V. Berenshtein Berenshtein ◽  
T.V. Lokhina Lokhina ◽  
I.N. Mozhzhukhina Mozhzhukhina ◽  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Acute Coronary Syndrome ◽  
Pulmonary Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Coronary Syndrome ◽  
The Impact

461Modulation of ischemic and bleeding risk by peripheral artery disease after an acute coronary syndrome

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Cespon Fernandez ◽  
S Raposeiras Roubin ◽  
E Abu-Assi ◽  
S Manzano-Fernandez ◽  
F Dascenzo ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Cumulative Incidence ◽  
Bleeding Risk ◽  
Peripheral Artery ◽  
Data Set ◽  
Coronary Syndrome ◽  
Artery Disease ◽  
The Impact

Abstract Introduction Peripheral artery disease (PAD) is associated with heightened ischemic and bleeding risk in patients with acute coronary syndrome (ACS). With this study from real-life patients, we try to analyze the balance between ischemic and bleeding risk during treatment with dual antiplatelet therapy (DAPT) after an ACS according to the presence or not of PAD. Methods The data analyzed in this study were obtained from the fusion of 3 clinical registries of ACS patients: BleeMACS (2004–2013), CardioCHUVI/ARRITXACA (2010–2016) and RENAMI (2013–2016). All 3 registries include consecutive patients discharged after an ACS with DAPT and undergoing PCI. The merged data set contain 26,076 patients. A propensity-matched analysis was performed to match the baseline characteristics of patients with and without PAD. The impact of prior PAD in the ischemic and bleeding risk was assessed by a competitive risk analysis, using a Fine and Gray regression model, with death being the competitive event. For ischemic risk we have considered a new acute myocardial infarction (AMI), whereas for bleeding risk we have considered major bleeding (MB) defined as bleeding requiring hospital admission. Follow-up time was censored by DAPT suspension/withdrawal. Results From the 26,076 ACS patients, 1,600 have PAD (6.1%). Patients with PAD were older, and with more cardiovascular risk factors. DAPT with prasugrel/ticagrelor was less frequently prescribed in patients with PAD in comparison with the rest of the population (8.2% vs 22.8%, p<0.001). During a mean follow-up of 12.2±4.8 months, 964 patients died (3.7%), and 640 AMI (2.5%) and 685 MB (2.6%) were reported. After propensity-score matching, we obtained two matched groups of 1,591 patients. Patients with PAD showed a significant higher risk of both AMI (sHR 2.17, 95% CI 1.51–3.10, p<0.001) and MB (sHR 1.51, 95% CI 1.07–2.12, p=0.018), in comparison with those without PAD. The cumulative incidence of AMI was 63.9 and 29.8 per 1,000 patients/year in patients with and without PAD, respectively. The cumulative incidence of MB was 55.9 and 37.6 per 1,000 patients/year in patients with and without PAD, respectively. The rate difference per 1,000 patient-years for AMI between patients with and without PAD was +34.1 (95% CI 30.1–38.1), and for MB +18.3 (16.1–20.4). The net balance between ischemic and bleeding events comparing patients with and without PAD was positive (+15.8 per 1,000 patients/year, 95% CI 9.7–22.0). Conclusions PAD was associated with higher ischemic and bleeding risk after hospital discharge for ACS treated with DAPT. However, the balance between ischemic and bleeding risk was positive for patients with PAD in comparison with patients without PAD. As summary, ACS patients with PAD had an ischemic risk greater than the bleeding risk.

Optimal Medical Therapy on Top of Dual-Antiplatelet Therapy: 1-Year Clinical Outcome in Patients With Acute Coronary Syndrome: The START Antiplatelet Registry

Angiology ◽  
2019 ◽  
Vol 71 (3) ◽  
pp. 235-241 ◽  
Author(s):  
Plinio Cirillo ◽  
Luigi Di Serafino ◽  
Vittorio Taglialatela ◽  
Paolo Calabrò ◽  
Emilia Antonucci ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Outcome ◽  
Antiplatelet Therapy ◽  
Medical Therapy ◽  
Real World ◽  
Dual Antiplatelet Therapy ◽  
Optimal Medical Therapy ◽  
Cerebrovascular Event ◽  
Coronary Syndrome ◽  
The Impact

Optimal medical therapy (OMT) at discharge is recommended after acute coronary syndrome (ACS). Few studies report the impact of OMT on long-term clinical outcome in a real-world scenario. We evaluated the impact of discharge OMT on top of dual-antiplatelet therapy (DAPT) on clinical outcome in the real-world ACS population of the Survey on anTicoagulated pAtients RegisTer ANTIPLATELET registry. The primary end point was major adverse cardiac and cerebrovascular event (MACCE), a composite of death, myocardial infarction, stroke, or target vessel revascularization. The co-primary end point was net adverse cardiac and cerebrovascular event (NACE), based on MACCE plus major bleeding. Consecutive patients with ACS with 1-year follow-up were enrolled. They were evaluated at discharge for the use of a β-blocker, angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers and statins. Optimal medical therapy was defined as the use of ≥2 of 3 medications. At multivariate analysis, both MACCE and NACE were significantly higher in non-OMT patients than in OMT patients (MACCE 18 [19] vs 59 [9], hazard ratio [HR] = 0.44 [0.26-0.75], P = .002, NACE 19 [20] vs 67 [10], HR = 0.47 [0.28-0.79], P = .004). In this real-world scenario, OMT at discharge on top of DAPT seems associated with a better clinical outcome compared with patients discharged on non-OMT.

Abstract P11: Use of Hospital Claims Data to Estimate the Clinical and Economic Burden of Acute Coronary Syndrome Rehospitalizations in Real-World Clinical Practice

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Gregory Hess ◽  
Durgesh Bhandary ◽  
Sanjay Gandhi ◽  
Deepa Kumar ◽  
Eileen Fonseca ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Real World ◽  
Hospitalization Rate ◽  
Index Hospitalization ◽  
Coronary Syndrome ◽  
Hospitalization Rates ◽  
St Elevation ◽  
The Mean

Background: Re-hospitalization rates are emerging as quality of care measures with reimbursement implications for inpatient care. Objective: To examine the rates of inpatient re-hospitalization and economic burden of acute coronary syndrome (ACS) patient admissions in real-world clinical practice. Methods: Patients (age >18 years) with an inpatient hospitalization for ACS [ICD-9-CM codes for acute myocardial infarction or unstable angina (UA)] between 1/1/2007-4/30/2009 were identified using claims from 450 hospitals representing 4.8 million inpatient visits. All-cause and ACS-related re-hospitalizations within 30 days and 12 months after index event were evaluated. In addition, the mean inpatient admission charges resulting from inpatient re-admissions at 30 days were also estimated. Results: Of 17,904 ACS patients [52% male; mean age 70.6 (median-73.0) years)], 13.3% had diagnostic coding for ST elevation myocardial infarction (STEMI), 47.9% had coding for non-ST elevation myocardial infarction (NSTEMI), 32.2% had UA, and 6.5% had not otherwise specified (NOS) ACS. The 30-day all-cause inpatient re-hospitalization rate was 14.7% (STEMI: 12.7%, NSTEMI: 17.1%, UA: 12.5%, NOS: 10.8%) and 5.5% for an ACS-related re-hospitalization (STEMI: 7.6%, NSTEMI: 7.0%, UA: 2.8%, NOS: 3.9%). The 12-month all cause re-hospitalization rate was 37.7% (STEMI: 31.3%, NSTEMI: 39.9%, UA: 39.7%, NOS: 25.4%) and 12.5% for an ACS-related re-hospitalization (STEMI: 12.7%, NSTEMI: 14.3%, UA: 10.9%, NOS: 7.0%). For patients with ages > 65 years (N = 12,627), the 30-day all-cause and ACS-related re-hospitalization rates were 15.1% and 5.8%, respectively. The mean per patient additional charges resulting from 30-day all-cause and ACS-related re-hospitalizations in the study cohort with an index hospitalization (N=17,904) were estimated to be $13,160 and $7,216, respectively. Conclusion: High rates of re-hospitalization for ACS patients within 30 days and 12-months post-index hospitalization were observed using real-world clinical practice data. More effective therapies may provide an opportunity to improve important clinical and economic outcomes in ACS patients.

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