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Intensive lipid‐lowering therapy in the 12 months after an acute coronary syndrome in Australia: an observational analysis
Author(s) -
Brieger David,
D'Souza Mario,
Hyun Karice,
Weaver James C,
Kritharides Leonard
Publication year - 2019
Publication title -
medical journal of australia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.904
H-Index - 131
eISSN - 1326-5377
pISSN - 0025-729X
DOI - 10.5694/mja2.12035
Subject(s) - medicine , acute coronary syndrome , observational study , intensive care , ezetimibe , odds ratio , emergency medicine , percutaneous coronary intervention , concordance , intensive care medicine , myocardial infarction , statin
Objective To determine the prevalence and identify predictors of people hospitalised with acute coronary syndrome ( ACS ) receiving intensive lipid‐lowering therapy during the 12 months after their discharge from hospital. Design Retrospective observational analysis. Setting Data were extracted from CONCORDANCE , a prospective, Australian investigator‐initiated ACS registry. Participants Patients enrolled in CONCORDANCE during January 2015 – May 2016 who survived to hospital discharge, for whom information on lipid‐lowering therapy 6 or 12 months after discharge from hospital were available. Main outcome measures Not receiving intensive lipid‐lowering therapy (with or without ezetimibe) at the most recent follow‐up (6 or 12 months); predictors of not receiving intensive lipid‐lowering therapy. Results 1876 of 3441 patients (55%) were receiving intensive lipid‐lowering therapy 6 or 12 months after their hospitalisation with an ACS . Predictors of not receiving intensive lipid‐lowering therapy included not been prescribed this treatment prior to their hospital admission (odds ratio [ OR ], 1.53; 95% CI , 1.26–1.85) or at hospital discharge ( aOR , 7.24; 95% CI , 4.37–12.0), being a woman ( aOR , 1.20; 95% CI , 1.02–1.41), and not being referred for cardiac rehabilitation ( aOR 1.39; 95% CI , 1.09–1.78). Patients who were managed medically in hospital (not revascularised; aOR , 1.54; 95% CI , 1.25–1.91) or underwent coronary artery bypass grafting ( aOR 1.55; 95% CI , 1.26–1.92) were less likely to be receiving intensive lipid‐lowering therapy at follow‐up than those with a percutaneous coronary intervention. Unmeasured hospital factors accounted for 17% of the variation in the likelihood of intensive lipid‐lowering therapy. Conclusions 45% of patients in Australia are not receiving intensive lipid‐lowering therapy in the 12 months after their ACS . Optimising oral lipid‐lowering therapy would reduce the recurrence of coronary events in this high risk group.