Increased uptake of guideline-recommended oral antiplatelet therapy: insights from the canadian XXXX reflective.

@entity1 @entity1187 @entity3076 @entity1397 @entity3077 @entity1459 @entity583 @entity857
Current guideline-based recommendations for oral dual-antiplatelet therapy in an @entity1187 ( @entity1187 ) include the use of newer @entity857 receptor inhibitor ( @entity857 ri) regimens and agents. The Canadian @entity1187 Reflective Program is a multicenter observational quality-enhancement project that compared the use of @entity857 ri therapy in 2 phases (November 2011-March 2013 and April 2013-November 2013) and also compared ADPri use with previous national data from the Canadian Global Registry of Acute Coronary Events (2000-2008). Of 3099 @entity1 with @entity1187 , 30.6% had @entity583 ( @entity583 ), 52.3% had non- @entity583 , and 17% had @entity1459 . There was high use of dual-antiplatelet therapy for  <= 24 hours, with important increases noted when compared with previous national experience (P for trend, < 0.0001). @entity1397 was the most commonly used @entity857 ri (82.2%), with lower use of the newer agents @entity3077 (9.0%) and @entity3076 (3.1%). Ticagrelor and @entity3076 use was most frequent in @entity1 with @entity583 undergoing percutaneous coronary intervention PCI (34.3%). There was relatively lower use of @entity857 ri therapy at discharge; it was given mainly to @entity1 who did not undergo PCI (68.2%) and to those with non-ST-elevation @entity1187 (82%). When comparing the 2 consecutive phases of data collection in the @entity1187 Reflective, there was an approximate 3- and 2-fold increase in the early and discharge use of the newer ADPri agents, respectively. In conclusion, there has been a temporal increase in ADPri use compared with previous national experience and an increased uptake of newer @entity857 ri agents. Additional work is needed to identify and address barriers limiting optimal implementation of these newer guideline-recommended agents into routine Canadian practice.
