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Comparative Study
. 2017 Oct 5;7(10):e017008.
doi: 10.1136/bmjopen-2017-017008.

Association between in-hospital guideline adherence and postdischarge major adverse outcomes of patients with acute coronary syndrome in Vietnam: a prospective cohort study

Thang Nguyen  1   2 , Khanh K Le  1 , Hoang T K Cao  1 , Dao T T Tran  1 , Linh M Ho  1 , Trang N D Thai  1 , Hoa T K Pham  3 , Phong T Pham  4 , Thao H Nguyen  5 , Eelko Hak  2 , Tam T Pham  6 , Katja Taxis  2
Affiliations
Comparative Study

Association between in-hospital guideline adherence and postdischarge major adverse outcomes of patients with acute coronary syndrome in Vietnam: a prospective cohort study

Thang Nguyen et al. BMJ Open. .

Abstract

Objective: We aimed to determine the association between physician adherence to prescribing guideline-recommended medications during hospitalisation and 6-month major adverse outcomes of patients with acute coronary syndrome in Vietnam.

Design: Prospective cohort study.

Setting: The study was carried out in two public hospitals in Vietnam between January and October 2015. Patients were followed for 6 months after discharge.

Participants: Patients who survived during hospitalisation with a discharge diagnosis of acute coronary syndrome and who were eligible for receiving at least one of the four guideline-recommended medications.

Exposures: Guideline adherence was defined as prescribing all guideline-recommended medications at both hospital admission and discharge for eligible patients. Medications were antiplatelet agents, beta-blockers, ACE inhibitors or angiotensin II receptor blockers and statins.

Main outcome measure: Six-month major adverse outcomes were defined as all-cause mortality or hospital readmission due to cardiovascular causes occurring during 6 months after discharge. Cox regression models were used to estimate the association between guideline adherence and 6-month major adverse outcomes.

Results: Overall, 512 patients were included. Of those, there were 242 patients (47.3%) in the guideline adherence group and 270 patients (52.3%) in the non-adherence group. The rate of 6-month major adverse outcomes was 30.5%. A 29% reduction in major adverse outcomes at 6 months after discharge was found for patients of the guideline adherence group compared with the non-adherence group (adjusted HR, 0.71; 95% CI, 0.51 to 0.98; p=0.039). Covariates significantly associated with the major adverse outcomes were percutaneous coronary intervention, prior heart failure and renal insufficiency.

Conclusions: In-hospital guideline adherence was associated with a significant decrease in major adverse outcomes up to 6 months after discharge. It supports the need for improving adherence to guidelines in hospital practice in low-income and middle-income countries like Vietnam.

Keywords: Guideline Adherence; Ischaemic Heart Disease; Major Adverse Outcomes; Prescribing.

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Conflict of interest statement

Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1
Flowchart of study population
Figure 2
Figure 2
Kaplan-Meier curves for two groups associated with major adverse outcomes
See this image and copyright information in PMC

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