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Outcomes, Health Costs and Use of Antiplatelet Agents in 7,082 Patients Admitted for an Acute Coronary Syndrome Occurring in a Large Community Setting

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Abstract

Purpose

To assess the outcomes of patients admitted for ACS and the prescription pattern of antiplatelets of patients discharged alive.

Methods

From the ARNO Observatory database, we performed a record linkage analysis of hospital discharge and prescription databases, which included 2,758,872 subjects of 7 Italian Local Health Authorities. The accrual period lasted from January 1 to December 31, 2008. Discharge records and prescription patterns were analyzed for 1 year before and after the accrual period.

Results

Of 2,758,872 subjects, 7,082 (2.6‰) were hospitalized for ACS. Mean age was 72 ± 13 years, females and diabetics accounted for 36 % and 25 % of the cases. Of the 7,082 patients, in-hospital death occurred in 6.9 %. Of the survivors, 64.5 % was treated medically, 35.5 % with PCI. Of the patients discharged alive, 65.8 % were treated with an antiplatelet, 21.9 % aspirin alone, 33.1 % aspirin plus a thienopyridine (mostly clopidogrel), 10.5 % a thienopyridine alone. Dual antiplatelet treatment was prescribed more frequently in patients treated with PCI than in those treated medically (57.3 % vs 19.7 %, p < 0.0001). At least one re-hospitalization occurred in 58.6 % (18.5 % for a recurrent episode of ACS, 24.8 % for other CV reasons, 15.3 % for non CV reasons). Prescription continuity to antiplatelets was observed in 68.0 % and 60.3 % of the patients, respectively at 6 and 12 months after discharge.

Conclusion

In a large community setting, the prescription rate of antiplatelets after ACS seems to be far from the guidelines recommendation. Rates of 1 year re-hospitalizations after ACS remain high, recurrence of ACS accounted for just one third of the cases.

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Acknowledgements

The authors would like to thank Barbara Bartolomei Mecatti for editorial assistance.

Funding Acknowledgements

This work was partially supported by an unrestricted grant from AstraZeneca.

Declaration of Conflicting Interests

None declared.

Author information

Authors and Affiliations

  1. ANMCO Research Center, Via La Marmora 34, 50121, Florence, Italy

    Aldo P. Maggioni & Gianna Fabbri

  2. CINECA, Interuniversitary Consortium, Bologna, Italy

    Elisa Rossi, Elisa Cinconze & Marisa De Rosa

  3. Health Economist, Bergamo, Italy

    Daniela P. Roggeri & Alessandro Roggeri

Authors
  1. Aldo P. Maggioni
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  2. Elisa Rossi
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  3. Elisa Cinconze
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  4. Daniela P. Roggeri
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  5. Alessandro Roggeri
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  6. Gianna Fabbri
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on the behalf of the ARNO Cardiovascular Observatory

Corresponding author

Correspondence to Aldo P. Maggioni.

Additional information

See Appendix for a complete list of participating Centers and Investigators.

Appendix

Appendix

Participating Centers and Investigators

R.Roni (Trento), A. De Marco (Belluno), M.Cecchetto (Bassano), MP Cariolato (Ovest Vicentino), A.Maroni (Vicenza), D.Maccari (Pieve di Soligo), R.Callegari (Asolo), ME Ferrari (San Donà di Piave), L.Cordella (Mirano), B.Pari (Chioggia), A.Pedrini (Alta Padovana), AM Grion (Padova), MG Zogno (Este), L.Monti (Rovigo), G.Rizzotti (Adria), L.Mezzalira (Verona), S.Brasola (Legnago), L.Castellani (Bussolengo), D.Garibaldi (Lucca), A.Giordani (Livorno), P.Batacchi (Firenze), M.Rais (Viareggio), A.Coccini (Genova), R.Di Turi (Roma A), C. De Matthaeis (Roma F), A. Orsini (Teramo), G. La Bella (Napoli1), E.Nava (Napoli 4), R.Moscogiuri (Taranto), MC Dessì (Nuoro)

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Maggioni, A.P., Rossi, E., Cinconze, E. et al. Outcomes, Health Costs and Use of Antiplatelet Agents in 7,082 Patients Admitted for an Acute Coronary Syndrome Occurring in a Large Community Setting. Cardiovasc Drugs Ther 27, 333–340 (2013). https://doi.org/10.1007/s10557-013-6455-z

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