Real-world analysis of characteristics and guideline adherence of antiplatelet drugs prescriptions among patients with coronary artery disease and its comorbidities: a cross-sectional study.

OBJECTIVES

To identify the characteristics of antiplatelet drug (APD) prescriptions based on a regional large-scale outpatient database in Shanghai, China, and to compare the practical usage of APDs with the respective clinical guidelines for patients with coronary artery disease (CAD) in China.

METHODS

Outpatient electronic healthcare records were extracted from 20 medical institutions in Shanghai from January 2020 to October 2021. Outpatient APD prescriptions among CAD patients and their comorbidity status were analyzed with the χ test. The guideline adherence of specific APD regimens was also evaluated.

RESULTS

Of 1,532,972 outpatient visits, only 284,400 (18.55%) involved APDs. APD were more likely to be utilized in patients with recent ACS (27.60%) (χ = 888.475, P < 0.001), CCS (n = 280025, 18.46%, χ = 881.045, P < 0.001) and coexisting hyperlipidemia (n = 22,387, 29.07%, χ = 5938.871, P < 0.001), diabetes (n = 14,087, 22.92%, χ = 808.226, P < 0.001), hypertension (n = 40,193, 22.11%, χ = 1724.758, P < 0.001) and atherosclerosis (n = 439, 21.24%, χ = 9.885, P = 0.002). Recent ACS patient and CCS patients with all comorbidities were more prone to being treated with dual aspirin-clopidogrel therapy (P < 0.001). Dual aspirin-ticagrelor therapy was the second common choice for CCS patients (n = 210,230, 13.86%, χ = 9.274, P = 0.002), followed by aspirin (n = 203,551, 13.42%; χ = 59.267, P < 0.001), clopidogrel (n = 75,702, 4.99%; χ = 4276.533, P < 0.001), and ticagrelor monotherapy (n = 7,94, 0.52%; χ = 4276.533, P < 0.001). Among recent ACS patients, clopidogrel monotherapy was the second most frequently used (n = 2624, 16.50%; χ = 4304.044, P < 0.001), followed by dual aspirin-ticagrelor therapy (n = 2071, 13.03%; χ = 9.101, P = 0.003), aspirin monotherapy (n = 1082, 11.33%; χ = 58.818, P < 0.001), and ticagrelor monotherapy (n = 354, 2.23%; χ = 847.68, P < 0.001). The rationality analysis showed that for CCS, the rating was 3 (representing the average). For recent ACS and CAD with reflux esophagitis, APD prescription was not very consistent with the guidelines (rating = 2).

CONCLUSION

The proportion of APD prescriptions for CAD outpatients was lower than expected. The rationality analysis revealed that both CCS and recent ACS patients showed suboptimal guideline adherence in real-world APD prescriptions, especially for patients with comorbid reflux esophagitis. The gap indicated that real-world prescription activity for these diseases should receive more attention.