acute coronary syndrome treatment; cardiovascular polypill; expert consensus; real-world practice; secondary prevention; Ramipril; Atorvastatin; Aspirin; Drug Combinations; Angiotensin-Converting Enzyme Inhibitors; Hydroxymethylglutaryl-CoA Reductase Inhibitors; Humans; Delphi Technique; Consensus; Angiotensin-Converting Enzyme Inhibitors/administration & dosage; Drug Therapy, Combination; Ramipril/administration & dosage; Atorvastatin/administration & dosage; Secondary Prevention/methods; Aspirin/administration & dosage; Aspirin/therapeutic use; Cardiovascular Diseases/prevention & control; Cardiovascular Diseases; Epidemiology; Community and Home Care; Cardiology and Cardiovascular Medicine
Abstract :
[en] [en] BACKGROUND: The SECURE trial demonstrated that the cardiovascular (CV)-polypill (acetylsalicylic acid [ASA] + atorvastatin + ramipril) reduces CV mortality by 33% in patients with acute myocardial infarction compared to standard care. The 2023 ACS ESC Guidelines recommend the polypill to improve outcomes and adherence.
OBJECTIVE: This study aims to establish a global consensus on the optimal use of the CV-polypill in secondary prevention.
METHODS: A two-round, modified Delphi method was used, featuring a 30-statement evidence-based questionnaire validated by eight renowned cardiologists. Fifty clinicians from 19 countries in Europe, Latin America, and Asia were invited to join the Delphi panel. Panelists ranked responses using a three-point Likert scale for agreement and importance. Consensus was defined as ≥80% agreement or rating statements 'very important' or 'important'. Statements without consensus after the first round were refined with evidence and feedback in the second round. Remaining disagreements were resolved in a face-to-face meeting. Descriptive statistics were applied.
RESULTS: Response rate was 76% (round 1) and 74% (round 2); 82% were cardiologists, with 74% frequently recommending the CV-polypill. Consensus was achieved on 93.3% of statements. Research showing a 24% relative risk reduction in major adverse CV events over a median of 3 years with the CV-polypill post-acute myocardial infarction, compared to usual care, reached 97.4% agreement for clinical implementation, and a 100% consensus supported polypill use at hospital discharge or first follow-up visits; 81.1% agreed on a prompt initiation after patient stabilization. There was agreement on algorithms for initiating (97.3%), considering patient preferences (97.4%) to the polypill and its cost savings over usual care (89.5%).
CONCLUSION: The Delphi consensus on real-world use of a CV polypill (ASA, atorvastatin, and ramipril) for secondary prevention post-acute coronary syndrome supports early initiation (within 8 days or at discharge). The findings provide a foundation to inform practice and policy, identifying priorities for further research.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Piñeiro, Daniel ; School of Medicine, University of Buenos Aires, Argentina
González-Juanatey, José Ramón ; Hospital Clínico Universitario, Santiago de Compostela, Galicia, Spain ; Centro de Investigación Biomédica en Red Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain ; Instituto de Investigación Sanitaria de Santiago (IDIS) Santiago de Compostela, Galicia, Spain
Abreu, Ana ; Centro de Reabilitação Cardiovascular, S. Cardiologia, Centro Hospitalar Universitário Lisboa Norte e Faculdade Medicina Universidade de Lisboa (FMUL), CAML, Lisbon, Portugal ; Instituto de Medicina Preventiva e Instituto de Saúde Ambiental da FMUL, Lisbon, Portugal
Alvarez, Enrique Gómez ; Centro Médico 20 de Noviembre, Mexico City, Mexico
Ponte-Negretti, Carlos ; Instituto Médico La Floresta, Caracas, Venezuela
Weisser, Burkhard ; Institute of Sports Science Christian Albrechts, University of Kiel, Kiel, Germany
Parkhomenko, Alexander ; National Scientific Centre named after Strazhensku (former Insitute of Cardiology), Kyiv, Ukraine
Araújo, Francisco ; Hospital Lusíadas, Lisbon, Portugal
Sosa-Liprandi, Alvaro ; Sanatorio Güemes, Buenos Aires, Argentina ; Inter-American Society of Cardiology, Mexico City, Mexico
Lancellotti, Patrizio ; Université de Liège - ULiège > Département des sciences cliniques > Cardiologie - Pathologie spéciale et réhabilitation
Language :
English
Title :
The Polypill (Acetyl Salicylic Acid, Atorvastatin, and Ramipril) Paradigm Shift in Secondary Prevention: Global Expert Delphi Consensus.
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