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Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects

Background: Patterns of real-world antiplatelet therapy (APT) are reported to differ from guideline recommendations. This study describes patterns of APT during the year following a hospital diagnosis of acute coronary syndrome (ACS) and possible implications in terms of revascularization rates, reh...

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Autores principales: Calabria, Silvia, Andreotti, Felicita, Ronconi, Giulia, Dondi, Letizia, Campeggi, Alice, Piccinni, Carlo, Pedrini, Antonella, Esposito, Immacolata, Addesi, Alice, Martini, Nello, Maggioni, Aldo Pietro
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410031/
https://www.ncbi.nlm.nih.gov/pubmed/36013127
http://dx.doi.org/10.3390/jcm11164888
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author Calabria, Silvia
Andreotti, Felicita
Ronconi, Giulia
Dondi, Letizia
Campeggi, Alice
Piccinni, Carlo
Pedrini, Antonella
Esposito, Immacolata
Addesi, Alice
Martini, Nello
Maggioni, Aldo Pietro
author_facet Calabria, Silvia
Andreotti, Felicita
Ronconi, Giulia
Dondi, Letizia
Campeggi, Alice
Piccinni, Carlo
Pedrini, Antonella
Esposito, Immacolata
Addesi, Alice
Martini, Nello
Maggioni, Aldo Pietro
author_sort Calabria, Silvia
collection PubMed
description Background: Patterns of real-world antiplatelet therapy (APT) are reported to differ from guideline recommendations. This study describes patterns of APT during the year following a hospital diagnosis of acute coronary syndrome (ACS) and possible implications in terms of revascularization rates, rehospitalizations, and costs for the Italian National Health Service. Methods: From >5 million people, patients discharged (=index date) with primary/secondary ACS diagnosis in 2017 were identified by cross-linkage of administrative health data collected by the Ricerca e Salute (ReS) Foundation. Patients were characterized by revascularization rates at index date, APT at one month and one year (with appropriate coverage defined as ≥80% of defined daily doses), and rehospitalizations and healthcare costs during follow-up. Results: From the 2017 ReS database, 7966 (1.46 × 1000 inhabitants) were discharged alive with an ACS diagnosis. Most were >69 years and male. Of these, 83% (6640/7966) received ≥1 recommended antiplatelet agent within one month (treated group): 23% (1870/7966) as single and 60% (4770/7966) as dual APT. Among the 53% undergoing revascularization, 81% received dual APT at one month. Of the 78% with the same APT at one year, 66% showed appropriate coverage. For subjects treated and untreated with APT at one month, one-year rehospitalization rates were 54% and 66%, respectively, and mean per capita costs were EUR 14,316 and EUR 16,552, respectively (hospitalization driving >80% of costs). Conclusions: Among survivors of a hospitalized ACS diagnosis, this analysis shows relatively high APT under-treatment at one month and one year, associated with fewer index revascularization rates, more rehospitalizations, and greater costs. Further initiatives to understand undertreatment and poor adherence should lead to improved health management and savings.
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spelling pubmed-94100312022-08-26 Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects Calabria, Silvia Andreotti, Felicita Ronconi, Giulia Dondi, Letizia Campeggi, Alice Piccinni, Carlo Pedrini, Antonella Esposito, Immacolata Addesi, Alice Martini, Nello Maggioni, Aldo Pietro J Clin Med Article Background: Patterns of real-world antiplatelet therapy (APT) are reported to differ from guideline recommendations. This study describes patterns of APT during the year following a hospital diagnosis of acute coronary syndrome (ACS) and possible implications in terms of revascularization rates, rehospitalizations, and costs for the Italian National Health Service. Methods: From >5 million people, patients discharged (=index date) with primary/secondary ACS diagnosis in 2017 were identified by cross-linkage of administrative health data collected by the Ricerca e Salute (ReS) Foundation. Patients were characterized by revascularization rates at index date, APT at one month and one year (with appropriate coverage defined as ≥80% of defined daily doses), and rehospitalizations and healthcare costs during follow-up. Results: From the 2017 ReS database, 7966 (1.46 × 1000 inhabitants) were discharged alive with an ACS diagnosis. Most were >69 years and male. Of these, 83% (6640/7966) received ≥1 recommended antiplatelet agent within one month (treated group): 23% (1870/7966) as single and 60% (4770/7966) as dual APT. Among the 53% undergoing revascularization, 81% received dual APT at one month. Of the 78% with the same APT at one year, 66% showed appropriate coverage. For subjects treated and untreated with APT at one month, one-year rehospitalization rates were 54% and 66%, respectively, and mean per capita costs were EUR 14,316 and EUR 16,552, respectively (hospitalization driving >80% of costs). Conclusions: Among survivors of a hospitalized ACS diagnosis, this analysis shows relatively high APT under-treatment at one month and one year, associated with fewer index revascularization rates, more rehospitalizations, and greater costs. Further initiatives to understand undertreatment and poor adherence should lead to improved health management and savings. MDPI 2022-08-20 /pmc/articles/PMC9410031/ /pubmed/36013127 http://dx.doi.org/10.3390/jcm11164888 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Calabria, Silvia
Andreotti, Felicita
Ronconi, Giulia
Dondi, Letizia
Campeggi, Alice
Piccinni, Carlo
Pedrini, Antonella
Esposito, Immacolata
Addesi, Alice
Martini, Nello
Maggioni, Aldo Pietro
Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects
title Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects
title_full Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects
title_fullStr Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects
title_full_unstemmed Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects
title_short Antiplatelet Therapy during the First Year after Acute Coronary Syndrome in a Contemporary Italian Community of over 5 Million Subjects
title_sort antiplatelet therapy during the first year after acute coronary syndrome in a contemporary italian community of over 5 million subjects
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9410031/
https://www.ncbi.nlm.nih.gov/pubmed/36013127
http://dx.doi.org/10.3390/jcm11164888
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