Use of evidence-based therapy for the secondary prevention of acute coronary syndromes in Malaysian practice Yaman Kassab Walid BPharm (AUST) MSc (Clinical Pharmacy) (JUST), 1 Yahaya Hassan BPharm (USM) C. PWT (USC) PharmD (Minn.), 2 Noorizan Abd Aziz BPharm (USM) MSc (Radiopharmacy)(USC), PharmD (Minn.), 2 Hadeer Akram BPharm (Baghdad University) MSc (Clinical Pharmacy) (USM), 1 Omar Ismail MD Masters Int Med (M’ sia) FACS (USA) 3 1 Researcher, Department of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia 2 Professor, Department of Clinical Pharmacy, Universiti Teknologi MARA, Puncak Alam Campus, Bandar Puncak Alam, Selangor, Malaysia 3 Consultant Cardiologist and Head, Department of Cardiology, Hospital Pulau Pinang, Pinang, Malaysia Keywords acute coronary syndromes, evidence-based pharmacotherapy, secondary prevention, utilization Correspondence Mr Yaman Walid Kassab Department of Clinical Pharmacy School of Pharmaceutical Sciences Universiti Sains Malaysia Pulau Pinang 11800 Malaysia E-mail: dryamankassab@yahoo.com Accepted for publication: 13 June 2012 doi:10.1111/j.1365-2753.2012.01894.x Abstract Rationale Despite the availability of various prevention guidelines on acute coronary syndrome (ACS), secondary prevention practice utilizing aspirin, beta-blockers, angio- tensin converting enzyme inhibitors and statins still can be sub-optimal. Aims and objectives To review and document the utilization of pharmacotherapy for the secondary prevention of ACS in patients discharged from a Malaysian hospital. Methods A retrospective cross-sectional study was conducted at a tertiary hospital in Penang, Malaysia. Patients with a primary diagnosis of ACS were identified from medical records over a 4-month period. A range of clinical data was extracted from medical records, including medical history, clinical presentation and pharmacotherapy both on admission and at discharge. This audit focused on the use of four guideline-recommended therapies: aspirinclopidogrel, beta-blockers, statins and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin II receptor blockers (ARBs). Results Data pertaining to a total of 380 ACS patients was extracted and reviewed, the mean age of the study population was 57.49 years and 73.9% of population was males. Patients with unstable angina accounted for 56.6% of the admissions whereas 23.4% and 20% of the patients were admitted for ST-elevation myocardial infarction and non-ST- segment elevation infarct respectively. 95.7% of the patients received antiplatelets com- prising of at least aspirin, and 82% received aspirin plus clopidogrel. Furthermore, 80.3% of the patients received a beta-blocker at discharge, 95% a statin and 69.7% received either an ACEI or ARB. Compared with patients who presented with myocardial infarction (with or without ST-segment elevation), those presenting with unstable angina were less likely to receive the combination of aspirin plus clopidogrel or an ACEI/ARB at discharge. Patients over 65 years of age were also less likely to receive a beta-blocker at discharge, compared with younger patients. Conclusions There is a good adherence to evidence-based guidelines for the secondary prevention of ACS in this local setting. However, there is some potential underutilization in the older population and patients presenting with unstable angina. Introduction Coronary artery disease (CAD) represents a major health problem in Malaysia. It continues to be the leading cause of admission and non-accidental death for the last 10 years [1,2], accounting for 20–25% of all deaths in government hospitals annually from 2000 to 2005 [3]. It is characterized pathologically by progressive occlu- sive atherosclerosis, acute plaque rupture and atherothrombosis. Atherothrombosis manifests clinically as acute coronary syndrome (ACS). ACS encompasses a number of cardiovascular presenta- Journal of Evaluation in Clinical Practice ISSN 1365-2753 © 2012 Blackwell Publishing Ltd, Journal of Evaluation in Clinical Practice 1