Medication Management For Secondary Prevention Among The Patients After Acute Coronary Syndrome

“The overall well-to-do can not be achieved without national health”,currently,“Healthy China” has already become one of the national strategies in China.However,the cardiovascular disease has affected the public health and been the disease which were most in need of intervention a healthy China.Acute coronary syndromes(ACS),is the most severe and common cardiovascular disease in clinical practice.ACS usually has acute onset and rapid progression,which severely threatens the human health and has brought heavy economic burden to the family and society.After ACS,the long-term medication management should be required for the patients,in order that the patients can use the antiplatelet agents normatively and compliably and make the secondary prevention useful and effective.However,the data about the medication management of antiplatelet agents in secondary prevention after ACS was still limited.Thereby,based on the Tianjin Urban Employee Basic Medical Insurance database(2011-2015),this study quantitatively evaluates the medication management level through various aspects including initiation,adherence and persistence among the ACS total patients and new-onset patients,in which,Initial treatment patterns were classified according to the first prescription at discharge and within the initial 30-day follow-up period.Patients who had a ≥80% proportion of days covered(PDC)were deemed adherent,while patients who had no gaps of ≥30 days in antiplatelet therapy were deemed persistent.Further,respectively explore the associated factors among the new-onset patients,to provide the effective suggestion to improve the medication management after ACS in Tianjian,China.Results indicated that 30.2% of the ACS patients were left untreated within the initial 30-day follow-up period.14.3% adhere to the antiplatelet agents and the mean PDC was 42.7% for the total patients.83.3% discontinued antiplatelet agents and the average time to discontinuation was 115.3 days.8,845 new-onset patients were identified,with a higher proportion of being left untreated within the initial period and discontinuation,while lower proportions of adherent,compared with total patients.Male and patients who received percutaneous coronary intervention(PCI)had better initiation,adherence,and persistence.Interestingly,the patients who had longer length of saty during the index event were less likely to initiate antiplatelet agents,but more likely to adherent and persist.In conclusion,the profile of medication administration is unsatisfactory,which also represents potential opportunities for improvement both for initial and long-tern management.Thus,government should strengthen publicity and education,deepen deepened acknowledgement to the rational drug administration for the secondary prevention among the ACS patients,improve the family doctor system including the level of utilization management of secondary prevention drug as performance appraisal,and should also provide the financial and technical support to make full use of insurance database to monitor the secondary prevention drug utilization.Medical institutions should pay more attention to the subpopulation who have more likely to not use drug rationally.Further,we should explore the new management mode of the rational drug use,to promote the level of reasonable drug use management.