Secondary Prevention Therapy after Acute Coronary Syndromes – Is Near Optimal Therapy Good Enough?

Abstracts

780 Secondary Prevention Therapy after Acute Coronary Syndromes – Is Near Optimal Therapy Good Enough? M. Yudi 1,∗ , N. Andrionopoulos 2 , O. Farouque 1 , J. Ramchand 1 , N. Jones 1 , D. Gayed 1 , A. Brennan 2 , S. Duffy 3 , A. Ajani 2 , G. New 4 , M. Sebastian 5 , E. Oqueli 6 , C. Reid 2 , D. Clark 1 1 Department

of Cardiology, Austin Health, Melbourne, Australia 2 Monash University, Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 3 Department of Cardiology, Alfred Health, Melbourne, Australia 4 Department of Cardiology, Box Hill Hospital, Melbourne, Australia 5 Department of Cardiology, Geelong Hospital, Melbourne, Australia 6 Department of Cardiology, Ballarat Hospital, Melbourne, Australia Introduction: Guidelines mandate optimal secondary prevention pharmacotherapy in all patients with acute coronary syndromes (ACS) The relative long-term mortality hazard of suboptimal medical therapy is poorly described. We aim to examine the prognostic relevance of adherence to optimal medical therapy (OMT). Methods: Consecutive patients with ACS from the Melbourne Interventional Group registry (2005-2013) who were alive 30 days following their index percutaneous coronary intervention were included. Patients were divided into three categories based on their use of secondary prevention pharmacotherapy (aspirin, P2Y12 inhibitor, beta blocker, ACE inhibitor/ARB, and statin). The OMT group received all 5 guideline-directed medications; the near-optimal medical therapy (NMT) received any 4 of the medications; and the suboptimal group (SMT) received ≤3 of the medications. Primary endpoint was long-term mortality through Australian National Death Index linkage. Results: Of the 9,375 patients included, 5,678(60.6%) received OMT, 2,903(31.0%) received NMT and 794(8.5%) received SMT. Patients receiving SMT were older, more likely to be female and had higher burden of co-morbidities. SMT was associated with higher long-term mortality (mean followup 3.9±2.2 years) when compared to NMT and OMT (16.8% vs. 10.5% vs. 8.2%, p=<0.001). Compared to OMT, SMT was an independent predictor of long-term mortality (OR 1.62, 95% CI 1.30-2.02, p<0.001) while NMT was not (OR 1.14, 95% CI 0.97-1.34, p=0.11). Conclusion: There is no significant mortality hazard in patients receiving near optimal secondary prevention therapy. This is reassuring for patients who can only tolerate 4 guideline-directed therapies. http://dx.doi.org/10.1016/j.hlc.2016.06.783

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781 Should All Patients Presenting With ST-Elevation Myocardial Infarction Be Screened for Familial Hypercholesterolaemia? D. Gayed, O. Farouque, D. Clark, N. Jones, J. Theuerle, K. Kalten, J. Ramchand, M. Yudi ∗ Department of Cardiology, Austin Health, Melbourne, Australia Background: Familial Hypercholesterolaemia (FH) is a common autosomal dominant genetic disorder associated with premature coronary artery disease. FH is underrecognised in the general population and often its first manifestation is acute myocardial infarction. We aim to ascertain the proportion of patients with STEMI who could be diagnosed with possible or probable FH. Method: Clinical and procedural characteristics of 286 consecutive patients presenting with STEMI who underwent primary percutaneous coronary intervention (PCI) at a major tertiary centre were prospectively collected. Patients were dichotomised according to the Dutch Lipid Clinic Network Score (DLCNS) into; possible/probable FH if their score was ≥3; or unlikely FH if their score was <3. The DLCNS is a validated FH screening tool that incorporates history, physical examination and LDL-cholesterol levels. Results: Of the 286 patients, 58 (20.3%) have possible or probable FH. This is likely an underrepresentation given the poor documentation of family history of premature vascular disease and presence/absence of clinical findings suggestive of FH. Patients with possible/probable FH are likely to be younger (51±8 vs. 66±13 years, p<0.01), male gender (90% vs. 77%, p=0.04), have a family history of premature CAD (86% vs. 24%, p<0.01) and have higher LDL-C levels (3.2±0.9 vs. 2.7±1.2, p<0.01). There was no difference in statin or ezetimibe discharge prescription between the groups. Conclusion: Given the significant proportion of patients presenting with STEMI who could be diagnosed with possible FH, screening should be strongly considered to enhance management of the index case and to facilitate family screening. http://dx.doi.org/10.1016/j.hlc.2016.06.784 782 Smartphone Apps to Improve Medication Adherence K. Santo ∗ , J. Chalmers, C. Chow, J. Redfern The George Institute for Global Health/ University of Sydney, Sydney, Australia Introduction: Recently, there has been a proliferation of smartphone apps that are advertised as the solution for improving medication adherence. In this review, we aimed to evaluate the features present in medication reminder apps available in app stores. Methods: Apps were identified in a systematic search of the Australian iTunes and Google Play app stores. Search