‘Suboptimal’ uptake of ACS medicines regimen: AIHW

More than a third of patients admitted to hospital with acute coronary syndrome (ACS) do not take up a multi-drug preventive regime up within 40 days of discharge, new analysis has found.
 
However, the patients that do are significantly more likely to stick to the regime if they regularly go to their GP, the research by the Australian Institute of Health and Welfare (AIHW) also suggests – backing up the conclusions of multiple previous studies.
 
The report, Medication use for secondary prevention after coronary heart disease hospitalisations, has also led to a call from RACGP President Adjunct Professor Karen Price for more Federal Government support for patients immediately after hospitalisation.
 
Released this week by the AIHW, the study flags a ‘suboptimal’ initial take up of the multi-drug regime recommended within the Australian Clinical Guidelines for the Management of Acute Coronary Syndromes to prevent secondary events.
 
The research looks at the use of statins, beta blocking agents, angiotensin-converting enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) medications, as well as antiplatelet agents.
 
It involved a cohort of 67,800 people who were hospitalised for coronary heart disease (CHD) between 1 July 2016 and 30 June 2017.
 
A further analysis compared medication uptake and adherence among the main group and a sub-group of 35,177 admitted with ACS, including those with heart attacks and unstable angina.
 
Only 61% of this latter cohort had taken up at least three of the four medications of the multi-drug regimen within 40 days of discharge, the researchers found.
 
Professor Price said those who make an unplanned visit to hospital due to ACS are more likely to be readmitted.
 
‘It would make a big difference if these people were supported to receive coordinated follow-up care with their GP after hospital,’ she said.
 
‘We are continuing to call for the Government to provide funding for patients to see their GP within seven days of an unplanned hospital admission or emergency department presentation – this will reduce re-admissions and help ensure patients have the best possible outcomes, including those with coronary heart disease.
 
‘And it will save the overall health budget in the long run by reducing expensive hospital re-admissions.’
 
The study found that 61% of those admitted to hospital with ACS visited their GP within a week of discharge – the same proportion found to have initiated the drug regimen within 40 days, although the research does not link the two figures.
 
Increased medication take-up was found among certain groups. These included those with more severe disease, older patients, those with previous CHD, diabetes, hypertension or congestive heart failure diagnoses, those who visited a cardiologist within 40 days, and those who were dispensed CVD medications in the 12 months before hospitalisation.
 
Women were among those significantly less likely to initiate medication within 40 days, as were those who underwent a coronary artery bypass graft.
 
Women were also found to have a lower likelihood of adherence to the medications overall, as were people with irregular GP contact.
 
The authors also said that the continuity and regularity of GP care is linked with improved odds of persistence and adherence to medication one year after being hospitalised.

‘These findings align with those of existing literature, which notes that higher continuity of care is associated with a better patient–GP therapeutic alliance, improved information continuity, higher levels of patient satisfaction and greater adherence to medical advice,’ they wrote.
 
Of the ACS cohort, a quarter were re-admitted to hospital within two years of the initial hospitalisation, the majority (56%) for CHD. Nine per cent of the cohort died.
 
The study acknowledged a number of limitations, including that it used the assumption the PBS dispensing data accurately matched medication use. It also noted that aspirin, an antiplatelet agent, can be purchased over the counter and was excluded from the analysis.
 
In a press release accompanying the research, AIHW spokesperson Miriam Lum On said further work is needed to assess why certain groups are less likely to access preventive medications or adhere to them.
 
‘The AIHW is working with closely with our expert advisory group on further analysis examining the relationship between medication adherence and the risk of subsequent hospitalisations and death,’ she said.
 
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