Evidence-based medication use among Chinese patients with acute coronary syndromes at the time of hospital discharge and 1 year after hospitalization: results from the Clinical Pathways for Acute Coronary Syndromes in China (CPACS) study

Am Heart J. 2009 Mar;157(3):509-516.e1. doi: 10.1016/j.ahj.2008.09.026. Epub 2008 Dec 17.


Background: Coronary heart disease has emerged as a leading cause of death in China. Although there is strong evidence for the use of antiplatelet, blood pressure-lowering, and lipid-lowering therapy in patients with acute coronary syndromes, the extent to which these medications are used in China remains uncertain.

Methods: We conducted a multicenter prospective study using data from consecutive patients diagnosed with suspected acute myocardial infarction or unstable angina pectoris admitted to the inpatient wards during the recruitment period. Medication adherence and reasons for nonadherence were reported using standardized questionnaires. Logistic regression was used to identify important patient and hospital characteristics associated with use of medication at 6 and 12 months after hospital discharge.

Results: The use of drug therapy was high (above 90% for aspirin, 70% for beta-blockers and angiotensin-converting enzyme inhibitors, 80% for statin) at the time of hospital discharge but decreased during follow-up. However, fewer than half (48%) of patients were discharged on 4-drug combination therapy (antiplatelet, beta-blocker, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, and statin), and the proportion remaining on this treatment 1 year after discharge was even lower (41%). In adjusted logistic regression analyses, medical insurance, dyslipidemia, hypertension, and administration of invasive therapy (percutaneous coronary intervention or coronary artery bypass graft) were important in determining use of treatment at discharge and during follow-up. In a substantial proportion of patients, medication was considered "not indicated" by the treating physician.

Conclusions: The findings highlight opportunities to improve the use and maintenance of appropriate combinations of evidence-based treatment among patients with acute coronary syndromes presenting to hospitals in China.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / drug therapy*
  • Acute Coronary Syndrome / epidemiology
  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • China
  • Coronary Disease / drug therapy
  • Evidence-Based Medicine
  • Female
  • Follow-Up Studies
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Logistic Models
  • Male
  • Middle Aged
  • Patient Compliance / statistics & numerical data
  • Platelet Aggregation Inhibitors / therapeutic use
  • Practice Patterns, Physicians'*
  • Prospective Studies
  • Registries
  • Risk Assessment


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors