Utilization of evidence-based secondary preventive therapies post-acute coronary syndrome: a heart registry cohort study in Kenya

Introduction: cardiovascular disease is a growing concern in Africa, with coronary artery disease emerging as a leading cause of mortality. Despite strong evidence and international guidelines recommending secondary prevention therapy post-acute coronary syndrome (ACS)-including antiplatelet agents, statins, beta blockers, and angiotensin-converting enzyme (ACE) inhibitors-suboptimal use remains a concern, especially in low-and middle-income countries. This study aimed to quantify the use of guideline-recommended secondary prevention medications after ACS in Kenya using the data from the Kenya Heart Registry study. Methods: a cohort study was conducted using data from the Kenya Heart Registry across three hospitals in Kenya from 2019 to 2023. Adult patients (≥18 years) diagnosed with ACS (ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina (UA)) were included. Clinical and sociodemographic data were extracted, including pharmacotherapy at presentation and discharge. Descriptive statistics and multivariate logistic regression (odds ratio (OR) and 95% confidence intervals) were used to assess patterns and predictors of medication use at discharge. Results: a total of 247 patients were included (168 STEMI, 79 NSTEMI/UA). Majority, 77.7% were males and 39.3% were above age of 65 years. More than 70% of the patients were overweight or obese. Use of secondary prevention therapy was low at home but increased significantly during hospitalization and remained high at discharge. At discharge, 91.4% of STEMI and 89.9% of NSTEMI/UA patients received aspirin; 88.3% and 84.8%, respectively, received statins. The odds of receiving a beta blocker at discharge were higher among patients with diabetes (OR=2.59) and dyslipidemia (OR=2.46), while patients with hypertension had higher odds of receiving ARB (OR=5.28). Conclusion: despite better in-hospital and discharge prescribing patterns, suboptimal pre-hospital medication use and underutilization of certain agents like ticagrelor at discharge highlight gaps in care. Tailored interventions-such as provider training, patient education, and strengthened transition-of-care protocols-are needed to improve long-term adherence to guideline-directed medical therapy after ACS in Kenya, particularly among high-risk groups.