@article {Chowe011122, author = {Clara K Chow and David Brieger and Mark Ryan and Nadarajah Kangaharan and Karice K Hyun and Tom Briffa}, editor = {, and , and Brieger, David and Xu, Kitty and Kilian, Jens and Myers, Jo-dee and Parkin, Ray and Morrison, Anne and Rajaratnam, Rohan and Tattam, Erin and Waites, Jonathon and Baldo, Clara and Kamaladasa, Kanishka and Davies, Maria and Collins, Nicholas and Nyman, Elizabeth and Blenkhorn, Adam and Boys, Janice and Juergens, Craig and Plotz, Elza and Fitzpatrick, Drew and Barry, Lisa and Amos, David and Ryan, Estelle and Adams, Mark and Watson, Danica and Alford, Kevin and Turnbull, Rhonda and Ryan, Mark and Robinson, Karley and Weaver, James and Shrestha, Prakriti and Chow, Clara and Tsang, Tracy and Shetty, Pratap Chandra and Stubbs, Renee and Farshid, Ahmad and Taverner, Pearle and Kangaharan, Nadarajah and Corkill, Wendy and Ilton, Marcus and Matthews, Krystal and Coverdale, Steve and Johnston, Colleen and Walters, Darren and Stibijl, Kathryn and Jayasinghe, Rohan and Gunter, Helen and Atherton, John and Palethorpe, Leeanne and Astridge, Penelope and Dalamaras, Tracey and Yadav, Raibhan and Farley, Tony and Chew, Derek and Wollaston, Fiona and Zeitz, Christopher and Rose, Jane and Zeitz, Christopher and Black, Marilyn and Antonis, Paul and McEwan, Janise and Shaw, James and Vandernet, Renee and Farouque, Omar and Brown, Louise and Mariani, Justin and Herbstreit, Renee and New, Gishel and Roberts, Louise and Amerena, John and Forgarty, Karen and Gaal, Willian van and Park, Mary and MacIsaac, Andrew and Wilson, Jenny and Rankin, Jamie and Vorster, Mary and Hung, Joseph and Ferguson, Louise and Roberts-Thomson, Phillip and Grabek, Teresa and Singh, Bhuwan and a{\textquoteright}Campo, Monika}, title = {Secondary prevention therapies in acute coronary syndrome and relation to outcomes: observational study}, volume = {11}, number = {1}, elocation-id = {e011122}, year = {2019}, doi = {10.1136/heartasia-2018-011122}, publisher = {British Medical Journal Publishing Group}, abstract = {Objective To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes.Methods CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months{\textquoteright} follow-up on 31 May 2016 were included. The main outcome measure was use of >=75\% of indicated medications (>=4/5 (or >=3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death.Results The mean age was 65{\textpm}13 years, 29\% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106{\textpm}30. At discharge, 92\% were on aspirin, 93\% lipid-lowering therapy, 78\% beta-blocker, 74\% ACE/angiotensin receptor blocker and 73\% a second antiplatelet; 89\% were taking >=75\% of medications at discharge, 78\% at 6 months and 66\% at 2 years. At 6 months, 38\% attended cardiac rehabilitation, 58\% received dietary advice and 32\% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on >=75\% vs \<75\% of medications (8.3\% vs 13.9\%; adjusted OR 0.75, 95 \% CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6\% vs 13.4\%; adjusted OR 0.44, 95\% CI 0.31 to 0.62).Conclusions Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years.}, URL = {https://heartasia.bmj.com/content/11/1/e011122}, eprint = {https://heartasia.bmj.com/content/11/1/e011122.full.pdf}, journal = {Heart Asia} }