Association Between In-hospital Guideline Adherence and Postdischarge Major Adverse Outcomes of Patients with Acute Coronary Syndrome in Vietnam: a Prospective Cohort Study

Overview

Journal BMJ Open

Specialty General Medicine

Date 2017 Oct 7

PMID 28982823

Citations 8

Authors

Thang Nguyen

Khanh K Le

Hoang T K Cao

Dao T T Tran

Linh M Ho

Trang N D Thai

Hoa T K Pham

Phong T Pham

Thao H Nguyen

Eelko Hak

Tam T Pham

Katja Taxis

Affiliations

Soon will be listed here.

Abstract

Objective: We aimed to determine the association between physician adherence to prescribing guideline-recommended medications during hospitalisation and 6-month major adverse outcomes of patients with acute coronary syndrome in Vietnam.

Design: Prospective cohort study.

Setting: The study was carried out in two public hospitals in Vietnam between January and October 2015. Patients were followed for 6 months after discharge.

Participants: Patients who survived during hospitalisation with a discharge diagnosis of acute coronary syndrome and who were eligible for receiving at least one of the four guideline-recommended medications.

Exposures: Guideline adherence was defined as prescribing all guideline-recommended medications at both hospital admission and discharge for eligible patients. Medications were antiplatelet agents, beta-blockers, ACE inhibitors or angiotensin II receptor blockers and statins.

Main Outcome Measure: Six-month major adverse outcomes were defined as all-cause mortality or hospital readmission due to cardiovascular causes occurring during 6 months after discharge. Cox regression models were used to estimate the association between guideline adherence and 6-month major adverse outcomes.

Results: Overall, 512 patients were included. Of those, there were 242 patients (47.3%) in the guideline adherence group and 270 patients (52.3%) in the non-adherence group. The rate of 6-month major adverse outcomes was 30.5%. A 29% reduction in major adverse outcomes at 6 months after discharge was found for patients of the guideline adherence group compared with the non-adherence group (adjusted HR, 0.71; 95% CI, 0.51 to 0.98; p=0.039). Covariates significantly associated with the major adverse outcomes were percutaneous coronary intervention, prior heart failure and renal insufficiency.

Conclusions: In-hospital guideline adherence was associated with a significant decrease in major adverse outcomes up to 6 months after discharge. It supports the need for improving adherence to guidelines in hospital practice in low-income and middle-income countries like Vietnam.

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