TY - JOUR AU - Aliprandi-Costa B. AU - Turnbull Fiona AU - Ranasinghe Isuru AU - Hyun K. AU - Chew DP AU - Astley C AU - Howell T AU - Carr B AU - Lintern K AU - Nallaiah K AU - Ferry C AU - Hammett C AU - Ellis CJ AU - French J AU - Brieger D AU - Briffa T AU - Redfern J AU - Chow Clara AB -

OBJECTIVE: To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care. METHODS: All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care. RESULTS: For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care. CONCLUSIONS: Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care.

AD - The George Institute for Global Health, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, Australia.
Department of Cardiovascular Medicine, Flinders University, Southern Adelaide Local Health Network, Adelaide, Australia.
Statewide Cardiac Clinical Network, South Australian Health; Flinders University, Adelaide, Australia.
The George Institute for Global Health, Sydney, Australia Sydney Medical School, University of Sydney, Sydney, Australia Westmead Hospital, Sydney, Australia.
Cardiology Department, Concord Hospital, Sydney, Australia.
The George Institute for Global Health, Sydney, Australia Queensland Health, Brisbane, Australia.
Cardiac Network, Agency for Clinical Innovation, Sydney, Australia.
The George Institute for Global Health, Sydney, Australia.
National Heart Foundation of Australia (New South Wales Division) Sydney, Australia.
Royal Brisbane Hospital, Brisbane, Australia.
Green Lane CVS Service, Auckland City Hospital, Auckland, New Zealand.
Liverpool Hospital Sydney, Australia University of New South Wales, Sydney Australia.
Sydney Medical School, University of Sydney, Sydney, Australia Cardiology Department, Concord Hospital, Sydney, Australia.
School of Population Health, University of Western Australia, Perth, Australia. AN - 24914060 BT - Heart C2 - 24914060 DA - 29754270115 DP - NLM ET - 2014/06/11 LA - Eng LB - CDV N1 - Redfern, Julie
Hyun, Karice
Chew, Derek P
Astley, Carolyn
Chow, Clara
Aliprandi-Costa, Bernadette
Howell, Tegwen
Carr, Bridie
Lintern, Karen
Ranasinghe, Isuru
Nallaiah, Kellie
Turnbull, Fiona
Ferry, Cate
Hammett, Chris
Ellis, Chris J
French, John
Brieger, David
Briffa, Tom
Heart. 2014 Jun 9. pii: heartjnl-2013-305296. doi: 10.1136/heartjnl-2013-305296. N2 -

OBJECTIVE: To evaluate the proportion of patients hospitalised with acute coronary syndrome (ACS) in Australia and New Zealand who received optimal inpatient preventive care and to identify factors associated with preventive care. METHODS: All patients hospitalised bi-nationally with ACS were identified between 14-27 May 2012. Optimal in-hospital preventive care was defined as having received lifestyle advice, referral to rehabilitation, and prescription of secondary prevention pharmacotherapies. Multilevel multivariable logistic regression was used to determine factors associated with receipt of optimal preventive care. RESULTS: For the 2299 ACS survivors, mean (SD) age was 69 (13) years, 46% were referred to rehabilitation, 65% were discharged on sufficient preventive medications, and 27% received optimal preventive care. Diagnosis of ST elevation myocardial infarction (OR: 2.64 [95% CI: 1.88-3.71]; p<0.001) and non-ST elevation myocardial infarction (OR: 1.99 [95% CI: 1.52-2.61]; p<0.001) compared with a diagnosis of unstable angina, having a percutaneous coronary intervention (PCI) (OR: 4.71 [95% CI: 3.67-6.11]; p<0.001) or coronary bypass (OR: 2.10 [95% CI: 1.21-3.60]; p=0.011) during the admission or history of hypertension (OR:1.36 [95% CI: 1.06-1.75]; p=0.017) were associated with greater exposure to preventive care. Age over 70 years (OR:0.53 [95% CI: 0.35-0.79]; p=0.002) or admission to a private hospital (OR:0.59 [95% CI: 0.42-0.84]; p=0.003) were associated with lower exposure to preventive care. CONCLUSIONS: Only one-quarter of ACS patients received optimal secondary prevention in-hospital. Patients with UA, who did not have PCI, were over 70 years or were admitted to a private hospital, were less likely to receive optimal care.

PY - 2014 SN - 1468-201X (Electronic)
1355-6037 (Linking) SP - pii: heartjnl EP - 305296 T2 - Heart TI - Prescription of secondary prevention medications, lifestyle advice, and referral to rehabilitation among acute coronary syndrome inpatients: results from a large prospective audit in Australia and New Zealand ER -