Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 4, Number 3, June 2013, pages 89-100

Healthcare Utilization of Patients With Acute Coronary Syndrome in Germany

Figure 1. Drop out of ACS patients due to deaths after discharge from the index hospitalization.

Figure 2. ACS patients with at least one prescription of the considered drugs for secondary prevention after ACS.

**Table 1.** Discharge Diagnoses of ACS Considered for Selection of Analysis Population
ICD-10 (GM)	Title
I20.0	Unstable angina
I21.0	Acute transmural myocardial infarction of anterior wall
I21.1	Acute transmural myocardial infarction of inferior wall
I21.2	Acute transmural myocardial infarction of other sites
I21.3	Acute transmural myocardial infarction of unspecified site
I21.4	Acute subendocardial myocardial infarction
I21.9	Acute myocardial infarction, unspecified

Table 1. Discharge Diagnoses of ACS Considered for Selection of Analysis Population

ICD-10 (GM)

Title

I20.0

Unstable angina

I21.0

Acute transmural myocardial infarction of anterior wall

I21.1

Acute transmural myocardial infarction of inferior wall

I21.2

Acute transmural myocardial infarction of other sites

I21.3

Acute transmural myocardial infarction of unspecified site

I21.4

Acute subendocardial myocardial infarction

I21.9

Acute myocardial infarction, unspecified

**Table 2.** Baseline Characteristics of the Study Population
	STEMI	NSTEMI/UA	Total
Patients (n)	11,430	33,758	45,188
Women (%)	42.89	49.56	47.87
Age (%)
0 – 50	11.68	6.27	7.64
51 – 60	18.83	13.78	14.92
61 – 70	26.06	26.61	26.47
71 – 80	25.32	30.87	29.47
81 +	18.64	22.46	21.50

Table 2. Baseline Characteristics of the Study Population

STEMI

NSTEMI/UA

Total

Patients (n)

11,430

33,758

45,188

Women (%)

42.89

49.56

47.87

Age (%)

0 – 50

11.68

6.27

7.64

51 – 60

18.83

13.78

14.92

61 – 70

26.06

26.61

26.47

71 – 80

25.32

30.87

29.47

81 +

18.64

22.46

21.50

**Table 3.** Frequency of Ambulatory Medical Care Within the First 360 Days After the Index Event in Comparison: ACS Diagnosis Versus CHD Diagnosis
	STEMI (N = 11,430)	NSTEMI/UA (N = 33,758)	Total (N = 45,188)
ACS
Patients with ACS-related ambulatory case (n (%))	7,233 (63.28)	8,360 (24.76)	15,593 (34.51)
CHD
Patients with CHD-related ambulatory case (n (%))	9,671 (84.61)	25,404 (75.25)	35,075 (77.62)
CHD-related ambulatory cases per patient (mean, SD)	8.87 ± 6.00	6.85 ± 5.36	7.41 ± 5.61

Table 3. Frequency of Ambulatory Medical Care Within the First 360 Days After the Index Event in Comparison: ACS Diagnosis Versus CHD Diagnosis

STEMI (N = 11,430)

NSTEMI/UA (N = 33,758)

Total (N = 45,188)

ACS

Patients with ACS-related ambulatory case (n (%))

7,233 (63.28)

8,360 (24.76)

15,593 (34.51)

CHD

Patients with CHD-related ambulatory case (n (%))

9,671 (84.61)

25,404 (75.25)

35,075 (77.62)

CHD-related ambulatory cases per patient (mean, SD)

8.87 ± 6.00

6.85 ± 5.36

7.41 ± 5.61

**Table 4.** Characteristics of ACS Patients With and Without an Index Prescription of Antiplatelet Drugs
	With index prescription for antiplatelet drug	No index prescription for antiplatelet drug
Patients (n (%))	20,202 (100.00)	9,083 (100.00)	29,285 (100.00)	13,556 (100.00)	2,347 (100.00)	15,903 (100.00)
Age (Means ± SD)	71.22 ± 11.32	67.14 ± 12.98	69.95 ± 12.01	69.63 ± 13.12	69.58 ± 14.57	69.62 ± 13.35
Patients older than 75 years (n (%))	7,683 (38.03)	2,533 (27.89)	10,216 (34.88)	4,708 (34.73)	880 (37.49)	5,588 (35.14)
Women (n, %)	9,117 (45.13)	3,694 (40.67)	12,811 (43.75)	7,614 (56.17)	1,208 (51.47)	8,822 (55.47)
Patients with ulcer diagnosis within the year before index event (ICD-10: K25-K28) (n (%))	624 (3.09)	190 (2.09)	814 (2.78)	425 (3.14)	54 (2.30)	479 (3.01)
Patients with prescription of antiplatelet drugs within the last 3 months before index event (n (%))	5,042 (24.96)	8,35 (9.19)	5,877 (20.07)	1,690 (12.47)	2,13 (9.08)	1,903 (11.97)
Patients with prescription of vitamin-k-antagonists within the first 100 days after index event (n (%))	962 (4.76)	448 (4.93)	1,410 (4.81)	1,610 (11.88)	293 (12.48)	1,903 (11.97)
Drop out within the first 30 days after the index event (n (%))	511 (2.53)	207 (3.38)	818 (2.79)	1,038 (7.66)	429 (18.28)	1,467 (9.22)
Drop out within the first 90 days after the index event (n (%))	1,787 (8.85)	788 (8.68)	2,575 (8.79)	2,254 (16.63)	705 (30.04)	2,959 (18.61)

Table 4. Characteristics of ACS Patients With and Without an Index Prescription of Antiplatelet Drugs

With index prescription for antiplatelet drug

No index prescription for antiplatelet drug

NSTEMI/UA

STEMI

Total

NSTEMI/UA

STEMI

Total

Patients (n (%))

20,202 (100.00)

9,083 (100.00)

29,285 (100.00)

13,556 (100.00)

2,347 (100.00)

15,903 (100.00)

Age (Means ± SD)

71.22 ± 11.32

67.14 ± 12.98

69.95 ± 12.01

69.63 ± 13.12

69.58 ± 14.57

69.62 ± 13.35

Patients older than 75 years (n (%))

7,683 (38.03)

2,533 (27.89)

10,216 (34.88)

4,708 (34.73)

880 (37.49)

5,588 (35.14)

Women (n, %)

9,117 (45.13)

3,694 (40.67)

12,811 (43.75)

7,614 (56.17)

1,208 (51.47)

8,822 (55.47)

Patients with ulcer diagnosis within the year before index event (ICD-10: K25-K28) (n (%))

624 (3.09)

190 (2.09)

814 (2.78)

425 (3.14)

54 (2.30)

479 (3.01)

Patients with prescription of antiplatelet drugs within the last 3 months before index event (n (%))

5,042 (24.96)

8,35 (9.19)

5,877 (20.07)

1,690 (12.47)

2,13 (9.08)

1,903 (11.97)

Patients with prescription of vitamin-k-antagonists within the first 100 days after index event (n (%))

962 (4.76)

448 (4.93)

1,410 (4.81)

1,610 (11.88)

293 (12.48)

1,903 (11.97)

Drop out within the first 30 days after the index event (n (%))

511 (2.53)

207 (3.38)

818 (2.79)

1,038 (7.66)

429 (18.28)

1,467 (9.22)

Drop out within the first 90 days after the index event (n (%))

1,787 (8.85)

788 (8.68)

2,575 (8.79)

2,254 (16.63)

705 (30.04)

2,959 (18.61)

**Table 5.** Characteristics of ACS Patients Without Any Prescription of Statins, β-Blocker and RAS Agents Within the First 180 Days After the Index Event
	NSTEMI/UA	STEMI	Total
Patients (n (%))	3,837 (100.00)	1,005 (100.00)	4,842 (100.00)
Age (mean ± SD)	67.32 ± 15.72	69.07 ± 16.31	67.68 ± 15.85
Patients older than 75 years (n (%))	1,302 (33.93)	398 (36.60)	1,700 (35.11)
Women (n (%))	2,017 (52.57)	517 (51.44)	2,534 (52.33)
Patients with index prescription of antiplatelet drugs (n (%))	558 (14.54)	121 (12.04)	679 (14.02)
Drop out within the first 30 days after the index event (n (%))	1,199 (31.25)	508 (50.55)	1,707 (35.25)
Drop out within the first 90 days after the index event (n (%))	2,595 (67.63)	849 (84.48)	3,444 (71.13)

Table 5. Characteristics of ACS Patients Without Any Prescription of Statins, β-Blocker and RAS Agents Within the First 180 Days After the Index Event

NSTEMI/UA

STEMI

Total

Patients (n (%))

3,837 (100.00)

1,005 (100.00)

4,842 (100.00)

Age (mean ± SD)

67.32 ± 15.72

69.07 ± 16.31

67.68 ± 15.85

Patients older than 75 years (n (%))

1,302 (33.93)

398 (36.60)

1,700 (35.11)

Women (n (%))

2,017 (52.57)

517 (51.44)

2,534 (52.33)

Patients with index prescription of antiplatelet drugs (n (%))

558 (14.54)

121 (12.04)

679 (14.02)

Drop out within the first 30 days after the index event (n (%))

1,199 (31.25)

508 (50.55)

1,707 (35.25)

Drop out within the first 90 days after the index event (n (%))

2,595 (67.63)

849 (84.48)

3,444 (71.13)

**Table 6.** Characteristics of ACS Patients Without a Prescription of Statins Within the First 180 Days After the Index Event
	Statins prescription	No statins prescription
Patients (n (%))	20,703 (100.00%)	8,783 (100.00%)	29,486 (100.00%)	13,055 (100.00%)	2,647 (100.00%)	15,702 (100.00%)
Age (mean ± SD)	69.96 ± 10.84	66.20 ± 12.53	68.85 ± 11.49	71.57 ± 13.81	72.34 ± 14.87	71.70 ± 14.00
Patients older than 75 years (n (%))	6,760 (32.65)	2,175 (24.76)	8,935 (30.30)	5,631 (43.13)	1,238 (46.77)	6,869 (43.75)
Women (n (%))	9,213 (44.50)	3,459 (39.38)	12,672 (42.98)	7,518 (57.59)	1,443 (54.51)	8,961 (57.07)
Patients with index prescription of antiplatelet drugs (n (%))	15,282 (73.82)	7,902 (89.97)	23,184 (78.63)	4,920 (37.69)	1,179 (44.54)	6,099 (38.84)
Patients with prescription of β-blockers within 180 days after index event (n (%))	17,552 (84.78)	8,110 (92.34)	25,662 (87.03)	7,041 (53.93)	1,342 (50.70)	8,383 (53.39)
Patients with prescription acting on RAS within 180 days after index event (n (%))	17,168 (82.93)	7,863 (89.53)	25,031 (84.89)	7,226 (55.35)	1,266 (47.83)	8,492 (54.08)
Drop out within the first 30 days after the index event (n (%))	350 (1.69)	228 (2.60)	578 (1.96)	1,199 (9.18)	508 (19.19)	1,707 (10.87)
Drop out within the first 90 days after the index event (n (%))	1,446 (6.98)	644 (7.33)	2,090 (7.03)	2,595 (19.88)	849 (32.07)	3,444 (21.93)

Table 6. Characteristics of ACS Patients Without a Prescription of Statins Within the First 180 Days After the Index Event

Statins prescription

No statins prescription

NSTEMI/UA

STEMI

Total

NSTEMI/UA

STEMI

Total

Patients (n (%))

20,703 (100.00%)

8,783 (100.00%)

29,486 (100.00%)

13,055 (100.00%)

2,647 (100.00%)

15,702 (100.00%)

Age (mean ± SD)

69.96 ± 10.84

66.20 ± 12.53

68.85 ± 11.49

71.57 ± 13.81

72.34 ± 14.87

71.70 ± 14.00

Patients older than 75 years (n (%))

6,760 (32.65)

2,175 (24.76)

8,935 (30.30)

5,631 (43.13)

1,238 (46.77)

6,869 (43.75)

Women (n (%))

9,213 (44.50)

3,459 (39.38)

12,672 (42.98)

7,518 (57.59)

1,443 (54.51)

8,961 (57.07)

Patients with index prescription of antiplatelet drugs (n (%))

15,282 (73.82)

7,902 (89.97)

23,184 (78.63)

4,920 (37.69)

1,179 (44.54)

6,099 (38.84)

Patients with prescription of β-blockers within 180 days after index event (n (%))

17,552 (84.78)

8,110 (92.34)

25,662 (87.03)

7,041 (53.93)

1,342 (50.70)

8,383 (53.39)

Patients with prescription acting on RAS within 180 days after index event (n (%))

17,168 (82.93)

7,863 (89.53)

25,031 (84.89)

7,226 (55.35)

1,266 (47.83)

8,492 (54.08)

Drop out within the first 30 days after the index event (n (%))

350 (1.69)

228 (2.60)

578 (1.96)

1,199 (9.18)

508 (19.19)

1,707 (10.87)

Drop out within the first 90 days after the index event (n (%))

1,446 (6.98)

644 (7.33)

2,090 (7.03)

2,595 (19.88)

849 (32.07)

3,444 (21.93)