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

Julie Redfern, Karice Hyun, Derek P. Chew, Carolyn Astley, Clara Chow, Bernadette Aliprandi-Costa, Tegwen Howell, Bridie Carr, Karen Lintern, Isuru Ranasinghe, Kellie Nallaiah, Fiona Turnbull, Cate Ferry, Chris Hammett, Chris J. Ellis, John French, David Brieger, Tom Briffa

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

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.

LanguageEnglish
Pages1281-1288
Number of pages8
JournalHeart
Volume100
Issue number16
DOIs
Publication statusPublished - 1 Jan 2014

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

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. / 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. In: Heart. 2014 ; Vol. 100, No. 16. pp. 1281-1288.
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title = "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",
abstract = "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.",
author = "Julie Redfern and Karice Hyun and Chew, {Derek P.} and Carolyn Astley and Clara Chow and Bernadette Aliprandi-Costa and Tegwen Howell and Bridie Carr and Karen Lintern and Isuru Ranasinghe and Kellie Nallaiah and Fiona Turnbull and Cate Ferry and Chris Hammett and Ellis, {Chris J.} and John French and David Brieger and Tom Briffa",
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Redfern, J, Hyun, K, Chew, DP, Astley, C, Chow, C, Aliprandi-Costa, B, Howell, T, Carr, B, Lintern, K, Ranasinghe, I, Nallaiah, K, Turnbull, F, Ferry, C, Hammett, C, Ellis, CJ, French, J, Brieger, D & Briffa, T 2014, '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', Heart, vol. 100, no. 16, pp. 1281-1288. https://doi.org/10.1136/heartjnl-2013-305296

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. / 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.

In: Heart, Vol. 100, No. 16, 01.01.2014, p. 1281-1288.

Research output: Contribution to journalArticle

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T2 - Heart

AU - Redfern, Julie

AU - Hyun, Karice

AU - Chew, Derek P.

AU - Astley, Carolyn

AU - Chow, Clara

AU - Aliprandi-Costa, Bernadette

AU - Howell, Tegwen

AU - Carr, Bridie

AU - Lintern, Karen

AU - Ranasinghe, Isuru

AU - Nallaiah, Kellie

AU - Turnbull, Fiona

AU - Ferry, Cate

AU - Hammett, Chris

AU - Ellis, Chris J.

AU - French, John

AU - Brieger, David

AU - Briffa, Tom

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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.

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.

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