scholarly journals Real-world incidence of patient-reported dyspnoea with ticagrelor

2018 ◽  
Vol 9 (10) ◽  
pp. 577-584 ◽  
Author(s):  
Adaire E. Prosser ◽  
Jessica L. Dawson ◽  
KethLyn Koo ◽  
Karen M. O’Kane ◽  
Michael B. Ward ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Agent ◽  
Standard Of Care ◽  
Drug Discontinuation ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Patient Reported ◽  
Observational Cohort

Dyspnoea, a common and multifactorial symptom in patients with acute coronary syndrome, has been associated with lower quality of life and hospital readmission. Prescriber preference for antiplatelet therapy, the standard of care in this patient group, is shifting to ticagrelor due to mortality benefits demonstrated in trials compared with clopidogrel. In these trials, dyspnoea was more commonly reported in patients prescribed ticagrelor but the aetiology is still debated. An observational cohort study was conducted to quantify the rates and severity of dyspnoea reported in patients with acute coronary syndrome and newly prescribed ticagrelor compared with those prescribed clopidogrel. Dyspnoea was more commonly reported in patients prescribed ticagrelor at each follow up post-discharge ( p = 0.016). Rates were higher than previously reported in clinical trials. In some patients, dyspnoea necessitated drug therapy change and was associated with readmission to hospital ( p = 0.046). As ticagrelor is widely prescribed as a first-line antiplatelet agent for a range of patients with acute coronary syndrome, the incidence of dyspnoea in a generalized patient cohort may result in higher rates of drug discontinuation. This in turn could lead to higher rates of rehospitalisation and potential treatment failure than that reported from the controlled setting of a clinical trial.

Frequency and Reasons of Dual Antiplatelet Therapy Discontinuation and Switching of P2Y12 Inhibitors in Patients with Acute Coronary Syndrome Treated with Stent Implantation

Cardiology ◽  
2019 ◽  
Vol 142 (4) ◽  
pp. 203-207
Author(s):  
Georgina Fuertes Ferre ◽  
Isabel Caballero Jambrina ◽  
Alejandra Ruiz Aranjuelo ◽  
Javier Jimeno Sánchez ◽  
Jose Gabriel Galache Osuna ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Stent Implantation ◽  
Dual Antiplatelet Therapy ◽  
Antiplatelet Agent ◽  
Invasive Procedure ◽  
Medical Decisions ◽  
P2y12 Inhibitors ◽  
Coronary Syndrome

Background: Incidence and reasons of dual antiplatelet therapy (DAPT) discontinuation and switching between P2Y12 inhibitors in acute coronary syndrome (ACS) patients treated with a stent have been poorly studied. Methods and Results: In a prospective single-center study, 283 consecutive patients presenting with ACS were treated with stent implantation between July 2015 and January 2016. Follow-up was achieved at 12 months in 273 patients using the electronic patient file and telephone interview. Switching from clopidogrel to a new antiplatelet agent (ticagrelor or prasugrel) or vice versa occurred in 60 (21.2%) patients. The most frequent reasons for switching were medical decisions not associated with bleeding events and concomitant use of chronic oral anticoagulation. Among the patients with a 1-year follow-up, 42 (15.4%) prematurely discontinued DAPT; 25 of them did so due to the need for an invasive procedure. DAPT premature discontinuation was not significantly associated with an increased 1-year risk of cardiovascular death or serious cardiac ischemic events (HR 2.08 [CI 95%: 0.88–4.94, p = 0.099]). Conclusions: DAPT discontinuation and switching between P2Y12 inhibitors are not uncommon in patients with ACS treated with a stent. The most frequent reasons were the need for an invasive procedure and medical decisions.

Abstract 095: Lessons Learned from the BRIDGE Registry: Major Findings From 8 Years of BRIDGE

2017 ◽  
Vol 10 (suppl_3) ◽  
Author(s):  
Morgan Bradford ◽  
Rachel Krallman ◽  
Colin McMahon ◽  
Daniel Montgomery ◽  
Eva Kline-Rogers ◽  
...  
Keyword(s):  
Transitional Care ◽  
The United States ◽  
Lessons Learned ◽  
Unplanned Readmission ◽  
Post Discharge ◽  
Care Clinic ◽  
Coronary Syndrome ◽  
Patient Reported ◽  
Comorbidity Scores

Background: Readmissions after cardiac hospitalizations are frequent and costly in the United States. Delays in follow-up and lack of adherence to guidelines may contribute to high unplanned readmission rates. Bridging the Discharge Gap Effectively (BRIDGE) is a nurse practitioner (NP) led, transitional care clinic for cardiac patients, aimed at reducing readmissions. Data on patients referred to BRIDGE has been collected since 2009; herein we report a summary of significant findings from these data. Methods: A qualitative review of results and conclusions from all published abstracts, oral presentations, and papers from the BRIDGE registry (June 2008-August 2015) was conducted. Content analysis was used to synthesize findings across studies. Results: Data from 3982 patients referred to BRIDGE have been collected. Seven themes were identified in the analysis of BRIDGE publications. During BRIDGE, NPs focused on medical history, symptoms, medication management (in 24.8% of visits), patient education, and referrals. In addition to addressing provider priorities, addressing patient concerns (daily living and clinical questions, feelings and fears) was highly salient, resulting in a high level of patient-NP connectedness as evidenced by high patient-reported scores on the Consultation and Relational Empathy scale (mean 43.5 ± 2.8; possible range 0, 50) and the Patient-Doctor Relationship Questionnaire (mean 43.05 ± 3.1; possible range 5, 45). Readmissions within 30 days were consistently lower for acute coronary syndrome (ACS) patients who attended BRIDGE compared to those who did not (6.4% v. 13.1%; p<0.01); similar results were not seen in heart failure (HF) (15.4% v. 15.7%; p=0.944) or atrial fibrillation (AF) (8.5% v. 5.2%; p=0.343) patients. A spike in HF readmissions was seen between 8-14 days post-discharge, suggesting the need for a sooner appointment. However, follow-up within 7 days of discharge did not show reduced readmissions in HF patients. AF readmissions were also difficult to avoid; in a subset of AF patients readmitted within 30 days, 51.1% (n=23) were readmitted for non-AF diagnoses. High risk patients (i.e. those with an adverse event before BRIDGE) were older, had higher Charlson comorbidity scores, and were more likely to have depression. However, marriage was associated with fewer readmissions. Conclusions: Data from the BRIDGE registry have shown that clinic attendance reduced ACS readmissions; has characterized older, depressed patients with higher Charlson comorbidity scores as being those most likely to be readmitted; and has identified areas for improvement in transitional care (e.g. AF and HF) where readmissions are difficult to avoid. Continuous quality improvement and real-time monitoring of patient outcomes have translated this research into more prompt transitional care, illustrating the importance of registry-based research.

scholarly journals Rationale and Design of the Future Optimal Research and Care Evaluation in Patients with Acute Coronary Syndrome (FORCE-ACS) Registry: Towards “Personalized Medicine” in Daily Clinical Practice

2020 ◽  
Vol 9 (10) ◽  
pp. 3173
Author(s):  
Dean R. P. P. Chan Pin Yin ◽  
Gert-Jan A. Vos ◽  
Niels M. R. van der Sangen ◽  
Ronald Walhout ◽  
R. Melvyn Tjon Joe Gin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Real World ◽  
Treatment Strategies ◽  
Medical Attention ◽  
Coronary Syndrome ◽  
Patient Reported ◽  
The Future ◽  
Care Evaluation

Diagnostic and treatment strategies for acute coronary syndrome have improved dramatically over the past few decades, but mortality and recurrent myocardial infarction rates remain high. An aging population with increasing co-morbidities heralds new clinical challenges. Therefore, in order to evaluate and improve current treatment strategies, detailed information on clinical presentation, treatment and follow-up in real-world patients is needed. The Future Optimal Research and Care Evaluation in patients with Acute Coronary Syndrome (FORCE-ACS) registry (ClinicalTrials.gov Identifier: NCT03823547) is a multi-center, prospective real-world registry of patients admitted with (suspected) acute coronary syndrome. Both non-interventional and interventional cardiac centers in different regions of the Netherlands are currently participating. Patients are treated according to local protocols, enabling the evaluation of different diagnostic and treatment strategies used in daily practice. Data collection is performed using electronic medical records and quality-of-life questionnaires, which are sent 1, 12, 24 and 36 months after initial admission. Major end points are all-cause mortality, myocardial infarction, stent thrombosis, stroke, revascularization and all bleeding requiring medical attention. Invasive therapy, antithrombotic therapy including patient-tailored strategies, such as the use of risk scores, pharmacogenetic guided antiplatelet therapy and patient reported outcome measures are monitored. The FORCE-ACS registry provides insight into numerous aspects of the (quality of) care for acute coronary syndrome patients.

What Is the Appropriate Duration of High-Dose Atorvastatin Therapy Post-Acute Coronary Syndrome?

2014 ◽  
Vol 28 (6) ◽  
pp. 555-560
Author(s):  
Pavel Goriacko ◽  
Matthew Andersen ◽  
Roman Fazylov ◽  
Roda Plakogiannis
Keyword(s):  
Acute Coronary Syndrome ◽  
English Language ◽  
Drug Discontinuation ◽  
High Dose ◽  
Coronary Syndrome ◽  
Search Terms ◽  
Atorvastatin Therapy ◽  
Coronary Syndromes ◽  
Coronary Events

Purpose: To determine the optimal duration of high-intensity atorvastatin therapy post-acute coronary syndrome (ACS). Summary: A literature review was conducted using the MEDLINE database (1966-October 2013) and employing the search terms “atorvastatin OR statins AND myocardial infarction OR acute coronary syndromes.” Clinical trials in the English language with available abstracts were used to identify potential data sources. Four major trials evaluating atorvastatin 80 mg daily after an ACS were identified. The duration of follow-up ranged from 16 weeks to a median of 4.9 years. High-dose atorvastatin regimens were associated with a reduction in coronary events but also with higher rates of drug discontinuation due to adverse reactions. The benefit of high-dose atorvastatin has been sustained for at least 5 years. Conclusion: After an ACS, high-dose atorvastatin should be continued for at least 5 years. High-dose atorvastatin demonstrated a reduction in coronary events but dose reductions and higher discontinuation rates were also noted.

scholarly journals Incidence and predictors of serious bleeding during long-term follow-up after acute coronary syndrome in a population-based cohort study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Anna Graipe ◽  
Anders Ulvenstam ◽  
Anna-Lotta Irevall ◽  
Lars Söderström ◽  
Thomas Mooe
Keyword(s):  
Heart Failure ◽  
Acute Coronary Syndrome ◽  
Bleeding Risk ◽  
Population Based ◽  
Bleeding Site ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Lower Baseline

AbstractProgress in decreasing ischemic complications in acute coronary syndrome (ACS) has come at the expense of increased bleeding risk. We estimated the long-term, post-discharge incidence of serious bleeding, characterized bleeding type, and identified predictors of bleeding and its impact on mortality in an unselected cohort of patients with ACS. In this population-based study, we included 1379 patients identified with an ACS, 2010–2014. Serious bleeding was defined as intracranial hemorrhage (ICH), bleeding requiring hospital admission, or bleeding requiring transfusion or surgery. During a median 4.6-year follow-up, 85 patients had ≥ 1 serious bleed (cumulative incidence, 8.6%; 95% confidence interval (CI) 8.3–8.9). A subgroup of 557 patients, aged ≥ 75 years had a higher incidence (13.4%) than younger patients (6.0%). The most common bleeding site was gastrointestinal (51%), followed by ICH (27%). Sixteen percent had a recurrence. Risk factors for serious bleeding were age ≥ 75 years, lower baseline hemoglobin (Hb) value, previous hypertension or heart failure. Serious bleeding was associated with increased mortality. Bleeding after ACS was fairly frequent and the most common bleeding site was gastrointestinal. Older age, lower baseline Hb value, hypertension and heart failure predicted bleeding. Bleeding did independently predict mortality.

scholarly journals The impact of socioeconomic status on secondary prevention of the acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Hyun ◽  
D Brieger ◽  
T Briffa ◽  
D Chew ◽  
M Horsfall ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Funding Source ◽  
Post Discharge ◽  
Coronary Syndrome ◽  
Group 3 ◽  
Group 5 ◽  
Universal Health ◽  
Group 1

Abstract Background Although socioeconomic status (SES) has been reported to be associated with health inequities, there are limited studies exploring the association between SES and secondary prevention of acute coronary syndrome (ACS) in countries with universal health cover. Purpose The aim is to examine whether SES has an impact on the secondary prevention of ACS in Australia. Methods Australian SNAPSHOT ACS data (2012) and its 18-month follow-up data were linked to admissions data from 6 jurisdictions covering all states and territories, national death index and Medicare Pharmaceutical Benefits Scheme data covering up to 3 years post-discharge. The five SES groups (lowest in Group 1 and highest in Group 5) were derived from the Australian Bureau of Statistics Socio-Economic Indexes for Areas (SEIFA) using the residential postcode at baseline. Outcomes were cardiac rehabilitation (CR) participation and smoking rate at 18 months post discharge as well as the use of ≥3 of the 4 indicated medications, all-cause death and cardiovascular disease (CVD) rates by 36 months of discharge. Outcomes were compared between the groups using the multilevel logistic regression with covariates of SES (5 groups), sex, GRACE risk score (4 groups), ACS diagnosis (STEMI/NSTEMI/UA) and the jurisdictions where the admissions data were linked. Results Of 1655 patients with ACS (mean age 68±13.5 yrs, 65% were male), who were discharged from hospital alive and had linked data available, 353 (21%) were in SES Group 1 (lowest SES), 369 (22%) in Group 2, 382 (23%) in Group 3, 296 (18%) in Group 4 and 255 (15%) in Group 5 (highest SES). Baseline clinical characteristics were comparable across the five SES groups. At 18-month after discharge, 1014 (61%) patients were followed-up with comparable loss to follow-up in each group. After adjustment, fewer patients in the lower SES groups (Groups 1 and 2) had participated in CR than those in the highest SES group (Group 5) (OR (95% CI): 0.60 (0.36, 0.99) and 0.56 (0.35, 0.91), respectively). Moreover, the odds of smoking was greater in Group 3 than Group 5 (2.60 (1.15, 5.89)) but no trend was found across the groups. By 36 months of discharge after adjustment, there was no difference in the odds of using ≥3 out of 4 medications between the SES groups. Despite this, patients in Groups 1 and 2 were significantly more likely to die than those in the highest SES group (1.96 (1.19, 3.21) and 1.91 (1.19, 3.07), respectively). The odds of CVD readmission did not differ across SES groups. Conclusion This study suggests that patients with low SES were less likely to participate in CR programs and more likely to die than those with high SES. Smoking rates varied between patients with intermediate and high SES but no trend was found across the groups. Despite the universal health cover available, inequity between the SES groups still exist. Future research is needed to further explore strategies to help close the evidence-practice gaps. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Australian National Heart Foundation Postdoctoral Fellowship

Severe diarrhoea due to use of P2Y12 inhibitor ticagrelor: a rarely reported adverse event

2021 ◽  
Vol 14 (7) ◽  
pp. e242199
Author(s):  
Khalid Rashid ◽  
Muhammad Aamir Waheed ◽  
Hafeez Ur Rehman ◽  
Abdel-Naser Elzouki
Keyword(s):  
Dual Antiplatelet Therapy ◽  
Antiplatelet Agent ◽  
Coronary Intervention ◽  
Severe Diarrhoea ◽  
P2y12 Inhibitor ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Patient Reported ◽  
Common Causes

Ticagrelor is a part of dual antiplatelet therapy (DAPT) which has proven benefits in patients with acute coronary syndrome especially in those undergoing percutaneous coronary intervention (PCI). However, like most other drugs, it can lead to undesired and adverse effects such as dyspnoea, easy bruising and gastrointestinal bleeding. We present a case of 70-year-old woman who developed diarrhoea following initiation of DAPT comprising of aspirin and ticagrelor following PCI. After excluding more common causes, it was attributed to ticagrelor administration and completely resolved after it was replaced with another oral antiplatelet agent. On follow-up, the patient reported complete resolution of symptoms.

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