Not all acute coronary syndrome patients get appropriate tx

(HealthDay)—Nearly one in five eligible patients hospitalized for acute coronary syndrome do not receive American College of Cardiology/American Heart Association (ACC/AHA) class I guideline-recommended angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) therapy, according to a study published online Feb. 25 in Circulation: Cardiovascular Quality and Outcomes.

Kevin R. Bainey, M.D., from the University of Alberta in Edmonton, Canada, and colleagues examined the extent to which ACEI/ARB therapy is applied in patients with acute coronary syndrome. Data were collected from 80,241 patients admitted with an acute coronary syndrome and discharged home from 311 U.S. hospitals participating in the Get With the Guidelines-Coronary Artery Disease Program (January 2005 to December 2009).

The researchers found that 81 percent of the 60,847 patients with an ACC/AHA class I indication (left ventricular dysfunction or medical history of heart failure, hypertension, diabetes mellitus, or chronic kidney disease) received ACEI/ARB. The rate of treatment increased over the study period (76.7 to 84.6 percent; adjusted odds ratio [OR], 1.17; P < 0.001, per calendar year). There were independent associations between in-hospital coronary bypass grafting (adjusted OR, 0.55) and renal insufficiency (adjusted OR, 0.58) with lower usage.

"These findings highlight an unmet need in this population and provide an incentive for additional quality improvement efforts," the authors write.

The Get With the Guidelines-Coronary Artery Disease Program is supported in part by Merck/Schering-Plough and Pfizer. Several authors disclosed financial ties to the medical device and pharmaceutical industries.