Baylor University Medical Center Proceedings October 2017 - 410

Evaluation of medication compliance for secondary
prevention of acute coronary syndrome
Dalvir Gill, MD, Elizabeth A. Feldman, PharmD, and Kan Liu, MD, PhD

To prevent recurrence of acute coronary syndrome (ACS), national
practice guidelines recommend use of five-drug combination therapy.
Our study assessed the proportion of patients discharged on all five
medications following ACS and determined reasons for nonadherence.
A retrospective, single-center chart review was conducted at a tertiary
academic medical center. Patients 18 years and older who were admitted
to the cardiac care unit with a diagnosis of ACS between January 2013
and January 2015 were included. Overall, 200 patients were screened
and 155 were included in the study. Half of the patients received all
guideline-recommended classes of pharmacological agents at discharge.
The other half-78 patients-did not receive the five-drug combination,
of whom 48 (62%) had reasons documented for nonadherence. Our
study's findings suggest that rates of adherence need to improve given
the clear benefits of these medications.
Figure 1. Patient distribution.

cute coronary syndrome (ACS) remains a major cause
of mortality worldwide due to recurrent cardiovascular
events. This study aimed to review and document
the current utilization and prescribing practices
of pharmacotherapy for the secondary prevention of ACS
in patients discharged from a cardiac care unit in a tertiary
academic medical center.
METHODS
A retrospective, single-center chart review was conducted
at State University of New York Upstate University Hospital.
Patients 18 years and older who were admitted to the cardiac care
unit with a diagnosis of ACS between January 2013 and January
2015 were included. Patients were excluded if they died during
the hospitalization, transferred care to another hospital, or had
a diagnosis other than ACS. Due to the retrospective retrieval
of the data, informed consent was not obtained. The study did
not oﬀer any risks to the patients' conﬁdentiality and privacy.
Using a standardized collection form, the following
demographic information was obtained: age at hospital
admission, sex, and past medical history including hypertension,
dyslipidemia, diabetes mellitus, coronary artery disease, and
tobacco use. Reasons for nonadherence were also collected.
Statistical analyses were performed using SPSS version 23.0
(IBM Corp, Chicago, IL). Data were presented using descriptive
410

statistics (mean ± standard deviation, median with interquartile
range, or number with percentage). Categorical variables were
compared using chi-square test for independence or Fisher exact
test. Continuous variables were compared using the Student
t test or Mann-Whitney U test. Odds ratios and 95% conﬁdence intervals were calculated when applicable. All tests were
two-tailed, and a P value < 0.05 was considered statistically
signiﬁcant.
RESULTS
A total of 200 patients were initially screened, of whom
45 were excluded due to diagnoses other than ACS, transfer
to other hospitals for higher level of care, or death during
hospitalization (Figure 1). Baseline demographic and clinical
characteristics are shown in Table 1. No statistically signiﬁcant
diﬀerences were noted between the adherent and nonadherent groups with respect to age, male gender, or past medical
history.
From the Department of Internal Medicine (Gill), Department of Pharmacy
(Feldman), and Division of Cardiology (Liu), State University of New York Upstate
Medical University, Syracuse, New York.
Corresponding author: Dalvir Gill, MD, Department of Internal Medicine, SUNY
Upstate Medical University, 60 Presidential Plaza, Apartment 1104, Syracuse,
NY 13202 (e-mail: gillda@upstate.edu).
Proc (Bayl Univ Med Cent) 2017;30(4):410-412

Table of Contents for the Digital Edition of Baylor University Medical Center Proceedings October 2017