Background
Patients with reduced left ventricular ejection fraction (EF<40%) are at high risk
for adverse outcomes and benefit from evidence based doses of angiotensin converting
enzyme inhibitors (ACEi), angiotensin II receptor blockers (ARB) and beta blockers.
Our aim was to investigate the dispensing and uptitration of these medications following
acute coronary syndrome (ACS), according to left ventricular ejection fraction.
Methods
Patients presenting with ACS who underwent coronary angiography during 2015 were recorded
in the All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry.
Medication dispensing data on discharge and at 1-year follow-up were obtained using
anonymised linkage to the national pharmaceutical dataset. Doses of medications dispensed
were compared to target doses recommended in clinical guidelines.
Results
4,082 patients were included in the study, of whom 602 (15%) had reduced ejection
fraction (rEF). More patients with rEF were prescribed ACEi/ARB on discharge compared
to those with preserved ejection fraction (pEF) (89% vs. 68%). Beta blocker dispensing
on discharge was also higher in the rEF group (94% vs. 83%). In the rEF subgroup,
76% were maintained on ACEi/ARB and 85% on beta blockers by 1 year of follow-up. However,
at discharge only 31% and 29% were on ≥50% of target doses of ACEi/ARB and beta blocker
doses respectively, and by 1 year this increased only slightly to 34% and 35% respectively.
Conclusions
There is suboptimal dispensing of evidence-based medications in the year following
ACS. Further intervention is required to improve medication uptitration and adherence,
particularly of beta blockers and ACEI/ARBs in those with reduced ejection fraction.
Keywords
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Article info
Publication history
Published online: April 13, 2020
Accepted:
March 1,
2020
Received in revised form:
February 15,
2020
Received:
November 30,
2019
Identification
Copyright
© 2020 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
