Reasons for discontinuation of recommended therapies according to the patients after acute coronary syndromes.

Gencer, Baris; Rodondi, Nicolas; Auer, Reto; Räber, Lorenz; Klingenberg, Roland; Nanchen, David; Carballo, David; Vogt, Pierre; Carballo, Sebastian; Meyer, Philippe; Matter, Christian M; Windecker, Stephan; Lüscher, Thomas Felix; Mach, François (2015). Reasons for discontinuation of recommended therapies according to the patients after acute coronary syndromes. European journal of internal medicine, 26(1), pp. 56-62. Elsevier 10.1016/j.ejim.2014.12.014

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BACKGROUND

The prescription of recommended medical therapies is a key factor to improve prognosis after acute coronary syndromes (ACS). However, reasons for cardiovascular therapies discontinuation after hospital discharge are poorly reported in previous studies.

METHODS

We enrolled 3055 consecutive patients hospitalized with a main diagnosis of ACS in four Swiss university hospitals with a prospective one-year follow-up. We assessed the self-reported use of recommended therapies and the reasons for medication discontinuation according to the patient interview performed at one-year follow-up.

RESULTS

3014 (99.3%) patients were discharged with aspirin, 2983 (98.4%) with statin, 2464 (81.2%) with beta-blocker, 2738 (90.3%) with ACE inhibitors/ARB and 2597 (100%) with P2Y12 inhibitors if treated with coronary stent. At the one-year follow-up, the discontinuation percentages were 2.9% for aspirin, 6.6% for statin, 11.6% for beta-blocker, 15.1% for ACE inhibitor/ARB and 17.8% for P2Y12 inhibitors. Most patients reported having discontinued their medication based on their physicians' decision: 64 (2.1%) for aspirin, 82 (2.7%) for statin, 212 (8.6%) for beta-blocker, 251 (9.1% for ACE inhibitor/ARB) and 293 (11.4%) for P2Y12 inhibitors, while side effect, perception that medication was unnecessary and medication costs were uncommon reported reasons (<2%) according to the patients.

CONCLUSIONS

Discontinuation of recommended therapies after ACS differs according the class of medication with the lowest percentages for aspirin. According to patients, most stopped their cardiovascular medication based on their physician's decision, while spontaneous discontinuation was infrequent.

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