Effect of evidence-based cardiac drug therapy on mortality in patients with acute coronary syndrome

Findings from the Gulf COAST registry

Ibrahim Al-Zakwani, Mohammad Zubaid, Alawi A. Alsheikh-Ali, Wael Almahmeed, Wafa Rashed

Research output: Contribution to journalArticle

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Abstract

Aim: To evaluate the prevalence and impact of the prescribing of an evidence-based cardiac medication (EBM) combination on 1-month, 6-months, and 12-months all-cause mortality in patients with acute coronary syndrome (ACS). Methods: Data were analyzed from 3681 consecutive patients diagnosed with ACS admitted to 29 hospitals in 4 Middle Eastern countries from January 2012 to January 2013. The EBM combination consisted of concurrent prescribing of an antiplatelet therapy, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), β-blocker, and a statin, at hospital discharge. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 60 ± 13 years, 66% (n = 2436) were males. In all, 69% (n = 2542) of the patients received the quadruple EBM combination at discharge. Two-way interactions between EBM and age (P = 0.824), EBM and GRACE risk score (P = 0.873) and between EBM and discharge diagnosis (P = 0.836) were all not statistically significant. Adjusting for demographic and clinical characteristics, the prescribing of EBM combination was associated with significantly lower cumulative all-cause mortality at 1-month (adjusted OR (aOR), 0.43; 95% confidence interval (CI): 0.24-0.79; P = 0.007), which persisted at 6-months (aOR, 0.52; 95% CI: 0.38-0.72; P < 0.001) and at 12-months of follow-up (aOR, 0.58; 95% CI: 0.44-0.75; P < 0.001) posthospital discharge. Conclusions: Among patients discharged after an ACS event, concurrent EBM prescribing was associated with lower all-cause mortality that persists for up to 12-months posthospital discharge. The relative benefits of EBMs were also consistent across age, GRACE risk score, and discharge diagnosis.

Original languageEnglish
JournalCardiovascular Therapeutics
DOIs
Publication statusAccepted/In press - Jan 1 2018

Fingerprint

Acute Coronary Syndrome
Registries
Drug Therapy
Mortality
Confidence Intervals
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Demography
Therapeutics

Keywords

  • acute coronary syndrome
  • Arabs
  • evidence-based medicine
  • Middle East
  • mortality

ASJC Scopus subject areas

  • Pharmacology
  • Cardiology and Cardiovascular Medicine
  • Pharmacology (medical)

Cite this

Effect of evidence-based cardiac drug therapy on mortality in patients with acute coronary syndrome : Findings from the Gulf COAST registry. / Al-Zakwani, Ibrahim; Zubaid, Mohammad; Alsheikh-Ali, Alawi A.; Almahmeed, Wael; Rashed, Wafa.

In: Cardiovascular Therapeutics, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Aim: To evaluate the prevalence and impact of the prescribing of an evidence-based cardiac medication (EBM) combination on 1-month, 6-months, and 12-months all-cause mortality in patients with acute coronary syndrome (ACS). Methods: Data were analyzed from 3681 consecutive patients diagnosed with ACS admitted to 29 hospitals in 4 Middle Eastern countries from January 2012 to January 2013. The EBM combination consisted of concurrent prescribing of an antiplatelet therapy, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), β-blocker, and a statin, at hospital discharge. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 60 ± 13 years, 66{\%} (n = 2436) were males. In all, 69{\%} (n = 2542) of the patients received the quadruple EBM combination at discharge. Two-way interactions between EBM and age (P = 0.824), EBM and GRACE risk score (P = 0.873) and between EBM and discharge diagnosis (P = 0.836) were all not statistically significant. Adjusting for demographic and clinical characteristics, the prescribing of EBM combination was associated with significantly lower cumulative all-cause mortality at 1-month (adjusted OR (aOR), 0.43; 95{\%} confidence interval (CI): 0.24-0.79; P = 0.007), which persisted at 6-months (aOR, 0.52; 95{\%} CI: 0.38-0.72; P < 0.001) and at 12-months of follow-up (aOR, 0.58; 95{\%} CI: 0.44-0.75; P < 0.001) posthospital discharge. Conclusions: Among patients discharged after an ACS event, concurrent EBM prescribing was associated with lower all-cause mortality that persists for up to 12-months posthospital discharge. The relative benefits of EBMs were also consistent across age, GRACE risk score, and discharge diagnosis.",
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AU - Almahmeed, Wael

AU - Rashed, Wafa

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N2 - Aim: To evaluate the prevalence and impact of the prescribing of an evidence-based cardiac medication (EBM) combination on 1-month, 6-months, and 12-months all-cause mortality in patients with acute coronary syndrome (ACS). Methods: Data were analyzed from 3681 consecutive patients diagnosed with ACS admitted to 29 hospitals in 4 Middle Eastern countries from January 2012 to January 2013. The EBM combination consisted of concurrent prescribing of an antiplatelet therapy, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), β-blocker, and a statin, at hospital discharge. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 60 ± 13 years, 66% (n = 2436) were males. In all, 69% (n = 2542) of the patients received the quadruple EBM combination at discharge. Two-way interactions between EBM and age (P = 0.824), EBM and GRACE risk score (P = 0.873) and between EBM and discharge diagnosis (P = 0.836) were all not statistically significant. Adjusting for demographic and clinical characteristics, the prescribing of EBM combination was associated with significantly lower cumulative all-cause mortality at 1-month (adjusted OR (aOR), 0.43; 95% confidence interval (CI): 0.24-0.79; P = 0.007), which persisted at 6-months (aOR, 0.52; 95% CI: 0.38-0.72; P < 0.001) and at 12-months of follow-up (aOR, 0.58; 95% CI: 0.44-0.75; P < 0.001) posthospital discharge. Conclusions: Among patients discharged after an ACS event, concurrent EBM prescribing was associated with lower all-cause mortality that persists for up to 12-months posthospital discharge. The relative benefits of EBMs were also consistent across age, GRACE risk score, and discharge diagnosis.

AB - Aim: To evaluate the prevalence and impact of the prescribing of an evidence-based cardiac medication (EBM) combination on 1-month, 6-months, and 12-months all-cause mortality in patients with acute coronary syndrome (ACS). Methods: Data were analyzed from 3681 consecutive patients diagnosed with ACS admitted to 29 hospitals in 4 Middle Eastern countries from January 2012 to January 2013. The EBM combination consisted of concurrent prescribing of an antiplatelet therapy, angiotensin-converting enzyme inhibitor (ACEI) or angiotensin II receptor blocker (ARB), β-blocker, and a statin, at hospital discharge. Analyses were performed using univariate and multivariate statistical techniques. Results: The overall mean age of the cohort was 60 ± 13 years, 66% (n = 2436) were males. In all, 69% (n = 2542) of the patients received the quadruple EBM combination at discharge. Two-way interactions between EBM and age (P = 0.824), EBM and GRACE risk score (P = 0.873) and between EBM and discharge diagnosis (P = 0.836) were all not statistically significant. Adjusting for demographic and clinical characteristics, the prescribing of EBM combination was associated with significantly lower cumulative all-cause mortality at 1-month (adjusted OR (aOR), 0.43; 95% confidence interval (CI): 0.24-0.79; P = 0.007), which persisted at 6-months (aOR, 0.52; 95% CI: 0.38-0.72; P < 0.001) and at 12-months of follow-up (aOR, 0.58; 95% CI: 0.44-0.75; P < 0.001) posthospital discharge. Conclusions: Among patients discharged after an ACS event, concurrent EBM prescribing was associated with lower all-cause mortality that persists for up to 12-months posthospital discharge. The relative benefits of EBMs were also consistent across age, GRACE risk score, and discharge diagnosis.

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