Persistence of combination of evidence-based medical therapy in patients with acute coronary syndromes.

Objective: To analyse long-term adherence persistence of evidence-based medical therapy in 'real-world' patients with coronary disease.

Methods: Cardiologists recruited the first three consecutive patients seen in either hospital clinics or private practice in 2006 who had been hospitalized for an acute coronary syndrome (ACS) in 2005 in France. Demographic characteristics, medical history, current treatments and medications at hospital discharge were recorded. The primary outcome was the persistence of the combination therapy comprising a beta-blocker, an antiplatelet, a statin and an angiotensin-converting enzyme (ACE) inhibitor (BASI).

Results: A total of 1700 patients were included in this French observational study. The mean time from hospital discharge to consultation was 14+/-4 months. At hospital discharge, BASI had been prescribed in 46.2% of patients, 80.2% of whom were still taking the combination at the consultation. Non-persistence was associated with severe noncardiovascular disease, atrial fibrillation and lack of significant coronary artery stenosis. When analysed separately, beta-blockers, antiplatelets, statins and ACE inhibitors had been prescribed at hospital discharge in 82.4, 98.9, 89.2 and 58%, respectively. Persistence over the 14-months period was greater than 86% for each of the drug classes. After hospital discharge, BASI was initiated in 8.5% of patients. Fourteen months after hospitalization for an ACS, 45.6% of patients were taking BASI.

Conclusions: Long-term persistence of BASI remained high after hospital discharge for an ACS, whereas the combination was started in a minority of those not discharged on this treatment. Fourteen months after an ACS, only half of the patients were receiving BASI, mainly due to failure to prescribe an ACE inhibitor at discharge. Our results highlight the importance of hospital prescription of BASI to obtain long-term persistence in ACS.