1. Pharmacotherapy in acute coronary syndromes Perspective from first line and regional hospitals in Czech Republic Cardionale, 26.11.2010 Petr Jansky

2. Pilot MI registry (n=3188) 6 non PCI hospitals Discharge pharmacotherapy Svobodová, 2008

3. All ACS patients 11/2005 N 1921 Widimský P. et al., Int J Cardiol, 2007 CZECH registry 1/ all PCI hospitals (80%) 2/ all community hospitals in two regions (20%)

4. Discharge pharmacotherapy STEMI % Mandelzweig, EHJ, 2006 Widimský, Int J Cardiol, 2007

5. Discharge pharmacotherapy nonSTE ACS % Widimský, Int J Cardiol, 2007

6. ESC Guidelines for the Management of NSTE-ACS Recommendations for performance measures Development of regional and/or national programmes to systematically measure performance indicators and provide feedback to individual hospitals is strongly encouraged (I-C). Development of regional and/or national programmes to systematically measure performance indicators and provide feedback to individual hospitals is strongly encouraged (I-C). European Heart Journal, July 2007

8. Confirmed acute coronary syndromes (STEMI, NONSTEMI, unstable AP) Continually since 1.7.2008 32 non cath hospitals

9. Quality of pharmacotherapy Prehospital phase Early hospital phase On discharge

10. Patient characteristics 7/2008-3/2010 Mean age  SD n% STEMI% malesmalesfemales 399527,560,666,8 ± 12,474,2 ± 11,0

11. Prehospital pharmacotherapy

12. Prehospital pharmacotherapy EMS vs physician

13. Prehospital pharmacotherapy

14. Evidence-based medical therapy (heparin, ASA, BB, statin, thienopyridin) within the first 24 hours after admission is associated with lower in-hospital mortality in NSTEMI Monhart et al., ESC 2008 N 1889, p < 0,001 %

15. Aspirin Linear trend: n.s. Pharmacotherapy within 24 hours after admission

16. Betablockers Linear trend: n.s. Pharmacotherapy within 24 hours after admission

17. ACEI Linear trend: n.s. Pharmacotherapy within 24 hours after admission

18. Clopidogrel Linear trend: p=0,023 Pharmacotherapy within 24 hours after admission

19. Statin Linear trend: p<0,001 Pharmacotherapy within 24 hours after admission

20. LMWH Linear trend: n.s. Pharmacotherapy within 24 hours after admission

21. Heparin Linear trend: p=0,036 Pharmacotherapy within 24 hours after admission

22. Fondaparinux Linear trend: p=0,011 Pharmacotherapy within 24 hours after admission

23. * p<0,05; ** p<0,01; *** p<0,001 %MalesFemales <=70 y >70 y STEMINSTEMI Aspirin90,888,492,787,4***92,989,7 * Clopidogrel69,660,8 ** 74,258,9 *** 77,465,4 *** Heparin25,819,6 * 28,219,1 *** 53,516,0 *** LMWH60,765,559,865,242,366,2 *** BB66,665,167,6 64,6 * 52,1 67,7 *** Fondaparinux16,015,216,315,0 9,319,5 *** ACEI59,660,260,159,547,360,3 *** Statin66,664,170,261,6 *** 53,865,6 ***

24. Aspirin Linear trend: n.s. Discharge pharmacotherapy

25. Clopidogrel Linear trend: n.s. Discharge pharmacotherapy

26. Clopidogrel on discharge – individual hospitals

27. Betablockers Linear trend: n.s. Discharge pharmacotherapy

28. Betablockers on discharge – individual hospitals

29. ACEI Linear trend: p=0,012 Discharge pharmacotherapy

30. Statin Linear trend: p<0,001 Discharge pharmacotherapy

31. Combination (aspirin, clopidogrel, BB, ACEI, statin) Linear trend: p=0,010 Discharge pharmacotherapy

32. %MalesFemales <=70 y >70 y STEMINSTEMI Aspirin93,591,695,6 89,9 *** 96,6 92,5 *** Clopidogrel74,2 62,9 *** 78,5 60,9 *** 87,3 71,6 *** BB85,283,486,0 83,0 * 86,184,0 ACEI79,877,679,978,182,3 77,0 ** Statin89,785,492,3 83,6 *** 91,4 85,7 ** * p<0,05; ** p<0,01; *** p<0,001

33. Conclusion Unsatisfactory prehospital pharmacotherapy In-hospital pharmacotherapy is relatively good (exc. elderly, females, NONSTEMI) Interhospital variability in the quality of care Improvement in some recommended therapies (statins, clopidogrel in the acute phase) over short time period

34. Thank you for your attention !