Increased uptake of guideline-recommended oral antiplatelet therapy: insights from the Canadian acute coronary syndrome reflective.

Abstract

Current guideline-based recommendations for oral dual-antiplatelet therapy in an acute coronary syndrome (ACS) include the use of newer adenosine diphosphate receptor inhibitor (ADPri) regimens and agents. The Canadian ACS Reflective Program is a multicenter observational quality-enhancement project that compared the use of ADPri therapy in 2 phases (November 2011-March 2013 and April 2013-November 2013) and also compared ADPri use with previous national data from the Canadian Global Registry of Acute Coronary Events (2000-2008). Of 3099 patients with ACS, 30.6% had ST-segment elevation myocardial infarction (STEMI), 52.3% had non-STEMI, and 17% had unstable angina. There was high use of dual-antiplatelet therapy for ≤ 24 hours, with important increases noted when compared with previous national experience (P for trend, < 0.0001). Clopidogrel was the most commonly used ADPri (82.2%), with lower use of the newer agents ticagrelor (9.0%) and prasugrel (3.1%). Ticagrelor and prasugrel use was most frequent in patients with STEMI undergoing percutaneous coronary intervention PCI (34.3%). There was relatively lower use of ADPri therapy at discharge; it was given mainly to patients who did not undergo PCI (68.2%) and to those with non-ST-elevation ACS (82%). When comparing the 2 consecutive phases of data collection in the ACS Reflective, there was an approximate 3- and 2-fold increase in the early and discharge use of the newer ADPri agents, respectively. In conclusion, there has been a temporal increase in ADPri use compared with previous national experience and an increased uptake of newer ADPri agents. Additional work is needed to identify and address barriers limiting optimal implementation of these newer guideline-recommended agents into routine Canadian practice.

• Authors: Sumeet Gandhi, Brigita Zile, Mary K Tan, Jhansi Saranu, Claudia Bucci, Andrew T Yan, Patrick Robertson, Mackenzie A Quantz, Eric Letovsky, Jean-Francois Tanguay, Jean-Pierre Dery, David Fitchett, Mina Madan, Warren J Cantor, Michael Heffernan, Madhu K Natarajan, Graham C Wong, Robert C Welsh, Shaun G Goodman, Canadian ACS Reflective Group
• Journal: The Canadian journal of cardiology (Can J Cardiol) Vol. 30 Issue 12 Pg. 1725-31 (Dec 2014) ISSN: 1916-7075 [Electronic] England
• PMID: 25475475 (Publication Type: Journal Article, Multicenter Study, Observational Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Chemical References

• Platelet Aggregation Inhibitors

Topics

• Acute Coronary Syndrome (drug therapy)
• Aged
• Canada
• Drug Administration Schedule
• Electrocardiography
• Female
• Follow-Up Studies
• Guideline Adherence
• Humans
• Male
• Platelet Aggregation Inhibitors (therapeutic use)
• Prospective Studies
• Registries
• Treatment Outcome