scholarly journals Life style patterns and adherence to pharmacotherapy after acute coronary syndrome: one year follow up study from a tertiary care center in Kashmir, India

2020 ◽  
Vol 8 (8) ◽  
pp. 2988
Author(s):  
Zubair A. Najar ◽  
Mohd Iqbal Dar ◽  
Mohd Iqbal Wani ◽  
Ajaz A. Lone ◽  
Hilal A. Rather ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Risk Factor ◽  
Life Style ◽  
Tertiary Care ◽  
Coronary Event ◽  
Uncontrolled Hypertension ◽  
Acute Coronary Event ◽  
Index Event ◽  
Coronary Syndrome

Background: Acute coronary syndrome is the leading cause of cardiac mortality and morbidity world over. Modification of life style pattern and adherence to pharmacotherapy plays a vital role in primary and secondary prevention of coronary events. This study was aimed at assessing the penetration of life style modifications and adherence to pharmacotherapy after acute coronary event in our population.Methods: Acute coronary syndrome patients enrolled in the study were examined, interviewed and all the demographic and clinical data was recorded at index event and at 3, 6 and 12 month intervals.Results: A total of 260 patients were enrolled in the study and followed for 12 months. Mean age of patients was 55.6±8.27 years. Males 78.6% and females 21.5%. Hypertension was risk factor in 67.7%, diabetes in 26.2%, smoking in 63.8%, BMI ≥25 in 67.3% and family history of coronary artery disease in 8.8% of the cases at index event. Uncontrolled hypertension was observed in 30.11%, 38.63% and 44.88% patients at 3, 6 and 12 months follow up. Uncontrolled diabetes at 3, 6 and 12 months was found in 58.82%, 66.17% and 73.52% patients. 5.42%, 15.06% and 21.08% cases continued to smoke at 3, 6 and 12 months respectively. Drug non-compliance overall was noted in 9.61%, 17.69% and 23.84% cases at 3, 6 and 12 month follow up.Conclusions: This study highlights the under prevalence of modifiable risk factor change in practice and drug non-compliance after an acute coronary event.

Adherence to dual anti-platelet therapy after acute coronary syndrome and its impact on patient outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Sulzgruber ◽  
H Sinkovec ◽  
N Kazem ◽  
F Hofer ◽  
A Hammer ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Acute Coronary Syndrome ◽  
Study Endpoint ◽  
Primary Study ◽  
Index Event ◽  
Coronary Syndrome ◽  
Anti Platelet Therapy ◽  
The Impact ◽  
Observation Period

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially dual anti-platelet therapy (DAPT) – including aspirin plus a P2Y12 inhibitor – proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and stent thrombosis. However, profound epidemiological measures on adherence to DAPT intake after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to DAPT after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to DAPT was investigated according to handing in prescriptions for aspirin and P2Y12 inhibitors at local pharmacies. Patients were followed prospectively until the primary study endpoint (=mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to DAPT on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 22.331 patients (median age: 65 years [55–75]; male: 69.7% [n=15.176]) met the inclusion criteria. Patients presenting with the indication for oral anticoagulation (n=2165; 9.7%), individuals that died during the index event (n=151; 0.7%), patients that presented with a re-ACS (n=396; 1.7%) or those who were lost during follow-up (n=96; 0.4%) were not included within the final analysis. Of alarming importance 70.7% (n=15.792) of all patients presenting with ACS did not take DAPT as recommended by current guidelines. The highest rate of drug interruption/end of therapy was observed within the first month after the index event with almost 50% of all cases. During patient follow-up until 14 months after the index event 513 individuals died. Non-adherence to DAPT proved a strong an independent association with mortality with an adjusted hazard ratio of 1.25 (95% CI: 1.09–1.41; p<0.001). (see Figure 1) Conclusion The present nationwide investigation highlighted an overall low adherence to DAPT after ACS, with the highest interruption/end of therapy rate within the first month after the index event. Since the intake of DAPT after ACS was associated with a 20% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of drug-adherence and intensified patient follow-up should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative Mortality Funding Acknowledgement Type of funding source: None

scholarly journals Percutaneous vascular closure device of the femoral access site after coronary interventions for acute coronary syndrome -immediate and short term follow-up

2017 ◽  
Vol 5 (3) ◽  
pp. 778 ◽  
Author(s):  
Ashraf Safiya Manzil ◽  
Sidharaj Vala ◽  
Sidharaj Vala
Keyword(s):  
Acute Coronary Syndrome ◽  
Interventional Procedure ◽  
Tertiary Care ◽  
Major Complication ◽  
Coronary Intervention ◽  
Closure Device ◽  
Short Term ◽  
Femoral Access ◽  
Coronary Syndrome

Background: Around 7 million patients undergo percutaneous interventional vascular procedures worldwide annually and this number is expected to escalate further in coming years. The aim of this study was to analyse immediate and short term follow up of patients with acute coronary syndrome (ACS) who had undergone percutaneous coronary intervention (PCI) through femoral route and closure with vascular closure device.Methods: This was non randomised, single centre study and was conducted in a tertiary care institution between January 2013 to June 2014 with 62 ACS patients undergoing femoral access invasive cardiac interventional procedure. Perclose A-T system was used in all patients as closure device. Patients were followed up to 15 days of clinical evaluation.Results: Of 62 ACS patients, 40 (64.5%) were with non-ST elevation myocardial infarction and 22 (35.5%) patients had history of unstable angina. The perclose device achieved closure within 5 to 10 minutes and all patients were kept in hospital stay for 2 to 3 days. There was one major complication of continuous bleeding, one incidence of small pseudo aneurysm, and two incidences of small hematomas with need of blood transfusion.Conclusions: This study demonstrates the ability of arterial closure device to safely and effectively achieve arterial closure in patients undergoing percutaneous intervention for ACS.

Adherence to high-intensity statin therapy after acute coronary syndrome and its impact on patient outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Sulzgruber ◽  
H Sinkovec ◽  
N Kazem ◽  
F Hofer ◽  
A Hammer ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
High Intensity ◽  
Lipid Lowering ◽  
Study Endpoint ◽  
Index Event ◽  
Coronary Syndrome ◽  
Observation Period

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially lipid lowering therapy – via high-intensity statins (atorvastatin and rosuvastatin) – proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and stent thrombosis. However, profound epidemiological measures on adherence to statin intake after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to high-intensity statin therapy after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to high-intensity statins was investigated according to handing in prescriptions for rosuvastatin and atorvastatin at local pharmacies. Patients were followed prospectively until the primary study endpoint (=mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to high-intensity statin therapy on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 23.240 patients (median age: 65 years [55–75]; male: 67.7% [n=15.728]) met the inclusion criteria. Individuals that died during the index event (n=366; 1.6%), presented with a re-ACS (n=569; 2.4%) or were lost during follow-up (n=158; 0.6%) were not included within the final analysis. Of alarming importance 66.4% (n=15.422) of all patients presenting with ACS did not take high-intensity statins as recommended by current guidelines. The highest rate of drug interruption/end of therapy was observed within the first month after the index event with more than 50% of all cases. During patient follow-up until 01/2018 a total of 3522 (15.2%) individuals died. Non-adherence to high-intensity statins had a strong an independent association with mortality with an adjusted hazard ratio of 1.16 (95% CI: 1.06–1.25; p<0.001) (see Figure 1). Conclusion The present nationwide investigation highlighted an overall low adherence to high-intensity statins after ACS, with the highest interruption/end of therapy rate within the first month after the index event. Since the intake of high-intensity statins after ACS was associated with a 14% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of drug-adherence and intensified patient follow-up should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative mortality Funding Acknowledgement Type of funding source: None

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