Acute coronary syndrome: real-world data from the Lombardy Region

BACKGROUND: The short-term outcomes of acute coronary syndrome (ACS) have been extensively studied; however, the role of post-discharge monitoring, treatment and rehabilitation in the prevention of long-term outcomes remains debated. The aim of this study was to measure the adherence to a therapeutic pathway and to assess its impact on the log-term risk of hospitalization for cardiovascular (CV) causes. METHODS: A total of 106 104 incident cases of ACS, in which patients aged 40-90 survived hospitalization, were recorded in the administrative databases between 2009-2015 and were identified as index shelters. Each patient had accumulated person-years from the index hospitalization discharge to the first of the following events: hospitalization for CV events or censorship (death, emigration, June 30, 2018). The association between exposure (drug therapy and rehabilitation) and risk of CV hospitalization was assessed using a Cox model in accordance to the intention-to-treat principle. RESULTS: Compared to untreated patients, those who received prescriptions of beta-blockers, statins, antiplatelet agents or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers in the year after the index discharge experienced a risk reduction of 13% (95% confidence interval [CI] 11-15%), 10% (95% CI 8-12%), 5% (95% CI 2-6%), and 3% (95% CI 1-6%), respectively, whereas rehabilitation within 2 months reduced the risk by 29% (95% CI 26-32%). CONCLUSIONS: Patients undergoing close monitoring with strict adherence to the recommended treatment after admission have a reduced risk of experiencing long-term CV events.