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Use of the recommended drug combination for secondary prevention after a first occurrence of acute coronary syndrome in France

  • Pharmacoepidemiology and Prescription
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Abstract

Purpose

The recommended pharmacotherapy for secondary prevention of acute coronary syndrome (ACS) is long-term treatment with a combination of four therapeutic classes: beta-blockers, antiplatelet agents (including aspirin), statins or other lipid-lowering agents, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. The aim of this study was to describe use and persistence of the recommended drug combination after the first occurrence of ACS in France.

Methods

This was a database cohort study of patients with first registration for ACS between 2004 and 2007 in a representative sample of the French healthcare insurance database (Echantillon Généraliste de Bénéficiaires, EGB). The drugs of interest were those recommended. Persistence was assessed for patients dispensed three or all four drug classes within 2 months following ACS. Discontinuation was defined by a gap of more than 6 weeks between two dispensations. The follow-up period was 24 months after ACS occurrence.

Results

Of 2,057 patients with incident ACS, 872 (42.4 %) had at least one dispensation of each of the four recommended drug classes, and 684 (33.3 %) had three of the four classes. Persistence to treatment at 24 months was 57.4 % (95 % CI [54.0-60.6]) for patients with four classes, and 55.5 % (95 % CI [51.6-59.1]) with three classes. Discontinuation of initial combination was higher in patients aged  ≥ 65 years at ACS occurrence, those with associated ongoing chronic disease, and in those who did not suffer myocardial infarction.

Conclusions

Post-ACS secondary prevention in France is not optimal, especially in patients who did not have myocardial infarction.

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Conflict of interest

The authors declare that they have no conflict of interest.

Contributions of Authors statement

J. Bezin: substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; drafting the article; and final approval of the version to be published.

A. Pariente: analysis and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published.

R. Lassalle: substantial contributions to conception and design, acquisition of data; revising the article critically for important intellectual content; and final approval of the version to be published.

C. Dureau-Pournin: analysis and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published.

A. Abouelfath: acquisition of data; revising the article critically for important intellectual content; and final approval of the version to be published.

P. Robinson: analysis and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published.

N. Moore: substantial contributions to conception and design, analysis and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published.

C. Droz-Perroteau: substantial contributions to conception and design, analysis and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published.

A. Fourrier-Reglat: substantial contributions to conception and design, analysis and interpretation of data; revising the article critically for important intellectual content; and final approval of the version to be published.

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Authors and Affiliations

  1. University of Bordeaux, Bordeaux, 33076, France

    J. Bezin, A. Pariente, R. Lassalle, C. Dureau-Pournin, A. Abouelfath, P. Robinson, N. Moore, C. Droz-Perroteau & A. Fourrier-Reglat

  2. INSERM CIC-P 0005, Bordeaux, 33076, France

    J. Bezin, A. Pariente, R. Lassalle, C. Dureau-Pournin, A. Abouelfath, P. Robinson, N. Moore, C. Droz-Perroteau & A. Fourrier-Reglat

  3. INSERM U657, Bordeaux, 33076, France

    J. Bezin, A. Pariente, N. Moore, C. Droz-Perroteau & A. Fourrier-Reglat

  4. CHU de Bordeaux, Bordeaux, 33076, France

    J. Bezin, A. Pariente, N. Moore & A. Fourrier-Reglat

  5. Service Hospitalo-Universitaire de Pharmacologie, Université de Bordeaux, CHU de Bordeaux, Bâtiment 1A, Zone Nord, Site Carriere, BP36, 33076, Bordeaux cedex, France

    J. Bezin

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  1. J. Bezin
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Bezin, J., Pariente, A., Lassalle, R. et al. Use of the recommended drug combination for secondary prevention after a first occurrence of acute coronary syndrome in France. Eur J Clin Pharmacol 70, 429–436 (2014). https://doi.org/10.1007/s00228-013-1614-5

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  • DOI: https://doi.org/10.1007/s00228-013-1614-5

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