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Association between in-hospital guideline adherence and postdischarge major adverse outcomes of patients with acute coronary syndrome in Vietnam: a prospective cohort study
  1. Thang Nguyen1,2,
  2. Khanh K Le1,
  3. Hoang T K Cao1,
  4. Dao T T Tran1,
  5. Linh M Ho1,
  6. Trang N D Thai1,
  7. Hoa T K Pham3,
  8. Phong T Pham4,
  9. Thao H Nguyen5,
  10. Eelko Hak2,
  11. Tam T Pham6,
  12. Katja Taxis2
  1. 1 Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
  2. 2 Groningen Research Institute of Pharmacy, Unit of PharmacoTherapy, Epidemiology & Economics, University of Groningen, Groningen, The Netherlands
  3. 3 Cardiac Ward, Can Tho General Hospital, Can Tho, Vietnam
  4. 4 Cardiac Ward, Can Tho Central General Hospital, Can Tho, Vietnam
  5. 5 Department of Clinical Pharmacy, School of Pharmacy, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh, Vietnam
  6. 6 Faculty of Public Health, Can Tho University of Medicine and Pharmacy, Can Tho, Vietnam
  1. Correspondence to Thang Nguyen; nthang{at}


Objective We aimed to determine the association between physician adherence to prescribing guideline-recommended medications during hospitalisation and 6-month major adverse outcomes of patients with acute coronary syndrome in Vietnam.

Design Prospective cohort study.

Setting The study was carried out in two public hospitals in Vietnam between January and October 2015. Patients were followed for 6 months after discharge.

Participants Patients who survived during hospitalisation with a discharge diagnosis of acute coronary syndrome and who were eligible for receiving at least one of the four guideline-recommended medications.

Exposures Guideline adherence was defined as prescribing all guideline-recommended medications at both hospital admission and discharge for eligible patients. Medications were antiplatelet agents, beta-blockers, ACE inhibitors or angiotensin II receptor blockers and statins.

Main outcome measure Six-month major adverse outcomes were defined as all-cause mortality or hospital readmission due to cardiovascular causes occurring during 6 months after discharge. Cox regression models were used to estimate the association between guideline adherence and 6-month major adverse outcomes.

Results Overall, 512 patients were included. Of those, there were 242 patients (47.3%) in the guideline adherence group and 270 patients (52.3%) in the non-adherence group. The rate of 6-month major adverse outcomes was 30.5%. A 29% reduction in major adverse outcomes at 6 months after discharge was found for patients of the guideline adherence group compared with the non-adherence group (adjusted HR, 0.71; 95% CI, 0.51 to 0.98; p=0.039). Covariates significantly associated with the major adverse outcomes were percutaneous coronary intervention, prior heart failure and renal insufficiency.

Conclusions In-hospital guideline adherence was associated with a significant decrease in major adverse outcomes up to 6 months after discharge. It supports the need for improving adherence to guidelines in hospital practice in low-income and middle-income countries like Vietnam.

  • Ischaemic Heart Disease
  • Guideline Adherence
  • Major Adverse Outcomes
  • Prescribing

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  • Contributors TN, KKL, HTKC and KT were responsible for the study concept and study design. TN, DTTT, LMH and TNDT were involved in data acquisition. All authors (TN, KKL, HTKC, DTTT, LMH, TNDT, HTKP, PTP, THN, EH, TTP and KT) were involved in analysis and interpretation of data. TN and KT drafted the manuscript, and all authors revised it critically for important intellectual content. All authors read and approved the final manuscript. TN and KT are guarantors and take full responsibility for the integrity of the data and the accuracy of the data analysis.

  • Funding This study was supported by the Vietnam International Education Development via the Project of Training Lecturers with PhD Degree for Universities and Colleges in the period from 2010 to 2020 (Project 911).

  • Competing interests All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Patient consent Obtained.

  • Ethics approval The study was approved by the institutional review boards of the Can Tho Central General Hospital and Can Tho General Hospital in Can Tho City, Vietnam. Verbal consent was obtained from all participants.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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