Title:Utilization of Evidence-Based Secondary Prevention Medications at the Time of Discharge in Patients with Acute Coronary Syndrome (ACS) in Qatar
VOLUME: 14 ISSUE: 4
Author(s):Maguy S. El-Hajj, Ahmed Saad, Jassim Al-Suwaidi, Wafa Z. Al-Marridi, Dana H. Elkhalifa, Alaa A. Mohamed and Ziyad R. Mahfoud
Affiliation:Chair of Clinical Pharmacy and Practice Section, College of Pharmacy Qatar University, Doha, Qatar 2713.
Keywords:Acute Coronary Syndrome, secondary prevention, evidence-based medication, antiplatelets, βeta-blocker, angiotensin
converting enzyme inhibitor, angiotensin II receptor blocker, statin, Qatar.
Abstract:Background and Objectives: In Qatar, ACS (Acute Coronary Syndrome) has become the
leading cause of morbidity and mortality. Guidelines recommend that ACS patients should receive indefinite
treatment with antiplatelets, β-blockers, angiotensin converting enzyme inhibitors (ACEIs) or
angiotensin II receptor blockers (ARBs) and statins. The study objectives were to assess the use of evidence-based secondary
prevention medication at discharge among ACS patients in Qatar and to determine the clinical and demographic
characteristics associated with the use of these medications.
Setting and Methods: A retrospective medical record review was conducted at the Heart Hospital in Qatar. A random
sample of 1068 ACS patients was selected. Patient characteristics were summarized. Prevalence of medications at discharge
were computed for each medication as well as for medication combinations. Multiple logistic regression was used
to detect patient variables that were associated with the outcomes. A p≤0.05 was considered significant.
Main Outcome Measures: -Percentage of ACS patients discharged on each of the following medications: antiplatelets
(aspirin, clopidogrel), β-blockers, ACEI or ARBs and statins and on the combination of these medications-Association between
the use of these medications and patient characteristics.
Results: In total, 1064 records were reviewed. The majority were males (85.3%) and about 1 in 5 (18.7%) were Qatari. At
discharge, patients were prescribed the following: aspirin (96.0%), clopidogrel (92.0%), -blockers (90.6%) and statins
(97.7%). ACEI and ARBs were prescribed to 63.5 and 11.3%, respectively. The concurrent 4 medications (aspirin or
clopidogrel, statins or other lowering cholesterol medication, β-blockers and ACEI or ARB) were prescribed to 773 patients
(77.8%; 95% confidence interval: 75.2-80.4%). Being overweight or obese, and having PCI (percutaneous coronary
intervention) or hypertension were associated with higher prescription of the concurrent medications. Those with diabetes
had a 52% increase in the odds of prescribing the 4 medications. Those with kidney disease had a 67% reduction in the
odds of prescribing.
Conclusion: Most ACS patients were prescribed antiplatelets, β-blockers and statins, but the use of ACEIs or ARBs was
suboptimal. Strategies are needed to enhance ACEI or ARB prescribing, especially for high risk patients who would have
the greatest therapeutic benefit from these drugs.
