e106 APRIL 2017 www.ajmc.com CLINICAL A cute coronary syndromes (ACS), encompassing ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina, are responsible for signifcant patient morbidity and mortality and are frequent causes of hospital admissions. Although the incidence of ACS and related coronary heart disease (CHD) has declined in recent decades, 1 CHD remains the leading cause of mortality (approximately one-third of all deaths). 2 Improvements in ACS outcomes have largely been attributed to reductions in major risk factors and advances in acute therapies, including coronary perfusion through percutane- ous coronary intervention (PCI), coronary artery bypass grafting, and improved medication management using 1 or more of the 5 major classes of cardioprotective agents: aspirin, P2Y 12 recep- tor inhibitors, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (ie, statins). 3,4 Optimal medication management during and following admission for ACS is critical to improving patient outcomes. 4 High rates of medication nonadherence are major contributors to poor outcomes following ACS. 5,6 Approximately one-third of patients will discontinue 1 or more cardiovascular medications within 3 months of discharge following admission for ACS, 7 with over half reporting nonadherence at 10 months. 8 Among other reasons, complex medication regimens and a high overall medication burden are directly related to medication nonadher- ence. 7,9 Medication complexity, including an increased number of medications being taken regularly, frequency of use, and special instructions (eg, take on an empty stomach, separate levothyrox- ine from calcium carbonate), is challenging enough for patients after discharge from an ACS admission, but confusing or unclear instructions can further complicate matters. 10 Quantifcation of patients’ medication regimens and modifcations to drug therapy during the peri-hospitalization period (ie, from admission to 90 days post discharge) in the real-world environment versus clinical trials is important to make valid inferences in usual practice. 11 The Medication Burden in Patients With Acute Coronary Syndromes Eric A. Wright, PharmD, MPH; Steven R. Steinhubl, MD; J.B. Jones, PhD, MBA; Pinky Barua, MSc, MBA; Xiaowei Yan, PhD; Ryan Van Loan, BA; Glenda Frederick, BA; Durgesh Bhandary, MS; and David Cobden, PhD, MPH, MSc, MBA ABSTRACT OBJECTIVES: Cardioprotective medications improve outcomes following acute coronary syndromes (ACS) but add to medication complexity. We set out to describe the use of these medications and quantify medication changes in patients admitted and discharged for ACS. STUDY DESIGN: Retrospective cohort study. METHODS: Using archived data from the electronic health record (EHR), we evaluated patients with ACS admitted to 1 of 2 hospitals between January 2008 and December 2012. Patients aged 18 to 89 years who were discharged with a principal diagnosis of ACS were included in the study. Descriptive statistics were compiled and medication use was compared at 3 time points: admission, discharge, and within 90 days post discharge. RESULTS: This study included 4767 patients. The mean number of total medications increased from 8.6 ± 6.5 to 11.4 ± 5.4 from admission to discharge, dropping slightly within 90 days post discharge (11.1 ± 5.2). Patients taking medications at least twice daily increased from 6.4 of 10 at admission to 9 of 10 at discharge. Cardioprotective medication use increased by a relative 76% for aspirin, 72% for statins, 85% for beta-blockers, and 29% for angiotensin- converting enzyme inhibitors/angiotensin II receptor blockers from admission to discharge, whereas P2Y 12 receptor inhibitor use increased 4-fold. CONCLUSIONS: Medication complexity among patients with ACS are high, with notable changes from admission to discharge. Awareness of the extent of medication burden provides clinicians and policy makers with insight to help address medication use during the ACS peri- hospitalization period. Am J Manag Care. 2017;23(4):e106-e112