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Pharmacotherapy in acute coronary syndromes

Pharmacotherapy in acute coronary syndromes. Perspective from first line and regional hospitals in Czech Republic. Petr Jansky. Cardionale , 26.11.2010. Pilot MI registry ( n=3188 ) 6 non PCI hospitals Discharge pharmacotherapy. Svobodová , 2008. CZECH registry. All ACS patients

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Pharmacotherapy in acute coronary syndromes

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  1. Pharmacotherapyin acutecoronarysyndromes Perspectivefromfirst line andregionalhospitalsin CzechRepublic Petr Jansky Cardionale, 26.11.2010

  2. Pilot MI registry (n=3188)6 non PCI hospitalsDischargepharmacotherapy Svobodová, 2008

  3. CZECH registry All ACS patients 11/2005 N 1921 1/ all PCI hospitals (80%) 2/ allcommunityhospitals in tworegions (20%) Widimský P. etal., IntJ Cardiol, 2007

  4. Dischargepharmacotherapy STEMI % Mandelzweig, EHJ, 2006 Widimský, Int J Cardiol, 2007

  5. DischargepharmacotherapynonSTE ACS % Widimský, Int J Cardiol, 2007

  6. Recommendations for performance measures • Development of regional and/or national programmes to systematically measure performance indicators and provide feedback to individual hospitals is strongly encouraged (I-C). European Heart Journal, July 2007

  7. Confirmedacutecoronarysyndromes (STEMI, NONSTEMI, unstableAP) • Continuallysince 1.7.2008 • 32 non cathhospitals

  8. Qualityofpharmacotherapy • Prehospitalphase • Earlyhospitalphase • On discharge

  9. Patientcharacteristics 7/2008-3/2010

  10. Prehospitalpharmacotherapy

  11. PrehospitalpharmacotherapyEMS vsphysician

  12. Prehospitalpharmacotherapy

  13. Evidence-based medical therapy (heparin, ASA, BB, statin, thienopyridin) within the first 24 hours after admissionis associated with lower in-hospital mortality in NSTEMI % N 1889, p < 0,001 Monhartetal., ESC 2008

  14. Pharmacotherapywithin 24 hoursafteradmission Aspirin Lineartrend:n.s.

  15. Pharmacotherapywithin24 hoursafteradmission Betablockers Lineartrend:n.s.

  16. Pharmacotherapywithin 24 hoursafteradmission Clopidogrel Lineartrend:p=0,023

  17. Pharmacotherapywithin24 hoursafteradmission Statin Linear trend:p<0,001

  18. Pharmacotherapywithin24 hoursafteradmission LMWH Lineartrend:n.s.

  19. Pharmacotherapywithin24 hoursafteradmission Heparin Lineartrend:p=0,036

  20. Pharmacotherapywithin24 hoursafteradmission Fondaparinux Lineartrend:p=0,011

  21. Pharmacotherapywithin24 hoursafteradmission * p<0,05; ** p<0,01; *** p<0,001

  22. Dischargepharmacotherapy Aspirin Lineartrend:n.s.

  23. Dischargepharmacotherapy Clopidogrel Lineartrend:n.s.

  24. Clopidogrelon discharge – individualhospitals

  25. Dischargepharmacotherapy Betablockers Lineartrend:n.s.

  26. Betablockers on discharge – individualhospitals

  27. Dischargepharmacotherapy ACEI Lineartrend:p=0,012

  28. Dischargepharmacotherapy Statin Lineartrend:p<0,001

  29. Dischargepharmacotherapy Combination(aspirin, clopidogrel, BB, ACEI, statin) Lineartrend:p=0,010

  30. Dischargepharmacotherapy * p<0,05; ** p<0,01; *** p<0,001

  31. Conclusion • Unsatisfactoryprehospitalpharmacotherapy • In-hospitalpharmacotherapyisrelativelygood (exc. elderly, females, NONSTEMI) • Interhospital variability in thequalityof care • Improvement in somerecommendedtherapies(statins, clopidogrelin theacutephase) overshorttime period

  32. Thankyouforyourattention !

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