Secondary preventive medication use in a prevalent population-based cohort of acute coronary syndrome survivors

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Abstract

Aim: Describe the dispensing patterns for guideline-recommended medications during 2008 in people with acute coronary syndrome (ACS) and how dispensing varies by gender and time since last ACS hospitalization. Method: A descriptive cohort spanning 20 years of people alive post-ACS in 2008. We extracted all ACS hospitalizations and deaths in Western Australia (1989–2008), and all person-linked Pharmaceutical Benefits Scheme claims nationally for 2008. Participants were 23 642 men and women (36.8%), alive and aged 65–89 years in mid-2008 who were hospitalized for ACS between 1989 and 2008. Main outcome was the proportion of the study cohort (in 2008) dispensed guideline-recommended cardiovascular medications in that year. Adjusted odds ratios estimating the association between type (and number) of guideline-recommended medications and time since last ACS hospitalization. Results: Medications most commonly dispensed in 2008 were statins (79.6% of study cohort) and then angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEi/ARBs) (71.1%), aspirin or clopidogrel (59.4%), and β-blockers (54.6%). Only 51.8% of the cohort was dispensed three or more of these drug types in 2008. Women with ACS were 18% less likely to be dispensed statins (adjusted odds ratio (OR)=0.82; 95% CI 0.76–0.88). Overall, for each incremental year since last ACS admission, there was an 8% increased odds (adjusted OR=1.08; 95% CI 1.07–1.08) of being dispensed fewer of the recommended drug regimen in 2008. Conclusion: Longer time since last ACS admission was associated with dispensing fewer medications types and combinations in 2008. Interventions are warranted to improve dispensing long term and any apparent gender inequality in the drug class filled.

Original languageEnglish
Pages (from-to)423-430
Number of pages8
JournalCardiovascular Therapeutics
Volume34
Issue number6
DOIs
Publication statusPublished - 1 Dec 2016

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Acute Coronary Syndrome
Survivors
Population
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hospitalization
clopidogrel
Odds Ratio
Guidelines
Pharmaceutical Preparations
Cohort Studies
Western Australia
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Aspirin

Cite this

@article{e80c31a43ae84312a79d35d5b714fafa,
title = "Secondary preventive medication use in a prevalent population-based cohort of acute coronary syndrome survivors",
abstract = "Aim: Describe the dispensing patterns for guideline-recommended medications during 2008 in people with acute coronary syndrome (ACS) and how dispensing varies by gender and time since last ACS hospitalization. Method: A descriptive cohort spanning 20 years of people alive post-ACS in 2008. We extracted all ACS hospitalizations and deaths in Western Australia (1989–2008), and all person-linked Pharmaceutical Benefits Scheme claims nationally for 2008. Participants were 23 642 men and women (36.8{\%}), alive and aged 65–89 years in mid-2008 who were hospitalized for ACS between 1989 and 2008. Main outcome was the proportion of the study cohort (in 2008) dispensed guideline-recommended cardiovascular medications in that year. Adjusted odds ratios estimating the association between type (and number) of guideline-recommended medications and time since last ACS hospitalization. Results: Medications most commonly dispensed in 2008 were statins (79.6{\%} of study cohort) and then angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEi/ARBs) (71.1{\%}), aspirin or clopidogrel (59.4{\%}), and β-blockers (54.6{\%}). Only 51.8{\%} of the cohort was dispensed three or more of these drug types in 2008. Women with ACS were 18{\%} less likely to be dispensed statins (adjusted odds ratio (OR)=0.82; 95{\%} CI 0.76–0.88). Overall, for each incremental year since last ACS admission, there was an 8{\%} increased odds (adjusted OR=1.08; 95{\%} CI 1.07–1.08) of being dispensed fewer of the recommended drug regimen in 2008. Conclusion: Longer time since last ACS admission was associated with dispensing fewer medications types and combinations in 2008. Interventions are warranted to improve dispensing long term and any apparent gender inequality in the drug class filled.",
keywords = "Acute coronary syndrome, Evidence-based practice, Gender, Pharmacoepidemiology, Prevention and control",
author = "Gunnell, {Anthony S.} and Joseph Hung and Knuiman, {Matthew W.} and Lee Nedkoff and Malcolm Gillies and Elizabeth Geelhoed and Hobbs, {Michael S T} and Katzenellenbogen, {Judith M.} and Rankin, {Jamie M.} and Michael Ortiz and Briffa, {Tom G.} and Sanfilippo, {Frank M.}",
year = "2016",
month = "12",
day = "1",
doi = "10.1111/1755-5922.12212",
language = "English",
volume = "34",
pages = "423--430",
journal = "Cardiovascular Therapeutics",
issn = "0897-5957",
publisher = "Wiley-Blackwell",
number = "6",

}

TY - JOUR

T1 - Secondary preventive medication use in a prevalent population-based cohort of acute coronary syndrome survivors

AU - Gunnell, Anthony S.

AU - Hung, Joseph

AU - Knuiman, Matthew W.

AU - Nedkoff, Lee

AU - Gillies, Malcolm

AU - Geelhoed, Elizabeth

AU - Hobbs, Michael S T

AU - Katzenellenbogen, Judith M.

AU - Rankin, Jamie M.

AU - Ortiz, Michael

AU - Briffa, Tom G.

AU - Sanfilippo, Frank M.

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Aim: Describe the dispensing patterns for guideline-recommended medications during 2008 in people with acute coronary syndrome (ACS) and how dispensing varies by gender and time since last ACS hospitalization. Method: A descriptive cohort spanning 20 years of people alive post-ACS in 2008. We extracted all ACS hospitalizations and deaths in Western Australia (1989–2008), and all person-linked Pharmaceutical Benefits Scheme claims nationally for 2008. Participants were 23 642 men and women (36.8%), alive and aged 65–89 years in mid-2008 who were hospitalized for ACS between 1989 and 2008. Main outcome was the proportion of the study cohort (in 2008) dispensed guideline-recommended cardiovascular medications in that year. Adjusted odds ratios estimating the association between type (and number) of guideline-recommended medications and time since last ACS hospitalization. Results: Medications most commonly dispensed in 2008 were statins (79.6% of study cohort) and then angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEi/ARBs) (71.1%), aspirin or clopidogrel (59.4%), and β-blockers (54.6%). Only 51.8% of the cohort was dispensed three or more of these drug types in 2008. Women with ACS were 18% less likely to be dispensed statins (adjusted odds ratio (OR)=0.82; 95% CI 0.76–0.88). Overall, for each incremental year since last ACS admission, there was an 8% increased odds (adjusted OR=1.08; 95% CI 1.07–1.08) of being dispensed fewer of the recommended drug regimen in 2008. Conclusion: Longer time since last ACS admission was associated with dispensing fewer medications types and combinations in 2008. Interventions are warranted to improve dispensing long term and any apparent gender inequality in the drug class filled.

AB - Aim: Describe the dispensing patterns for guideline-recommended medications during 2008 in people with acute coronary syndrome (ACS) and how dispensing varies by gender and time since last ACS hospitalization. Method: A descriptive cohort spanning 20 years of people alive post-ACS in 2008. We extracted all ACS hospitalizations and deaths in Western Australia (1989–2008), and all person-linked Pharmaceutical Benefits Scheme claims nationally for 2008. Participants were 23 642 men and women (36.8%), alive and aged 65–89 years in mid-2008 who were hospitalized for ACS between 1989 and 2008. Main outcome was the proportion of the study cohort (in 2008) dispensed guideline-recommended cardiovascular medications in that year. Adjusted odds ratios estimating the association between type (and number) of guideline-recommended medications and time since last ACS hospitalization. Results: Medications most commonly dispensed in 2008 were statins (79.6% of study cohort) and then angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEi/ARBs) (71.1%), aspirin or clopidogrel (59.4%), and β-blockers (54.6%). Only 51.8% of the cohort was dispensed three or more of these drug types in 2008. Women with ACS were 18% less likely to be dispensed statins (adjusted odds ratio (OR)=0.82; 95% CI 0.76–0.88). Overall, for each incremental year since last ACS admission, there was an 8% increased odds (adjusted OR=1.08; 95% CI 1.07–1.08) of being dispensed fewer of the recommended drug regimen in 2008. Conclusion: Longer time since last ACS admission was associated with dispensing fewer medications types and combinations in 2008. Interventions are warranted to improve dispensing long term and any apparent gender inequality in the drug class filled.

KW - Acute coronary syndrome

KW - Evidence-based practice

KW - Gender

KW - Pharmacoepidemiology

KW - Prevention and control

UR - http://www.scopus.com/inward/record.url?scp=84995503412&partnerID=8YFLogxK

U2 - 10.1111/1755-5922.12212

DO - 10.1111/1755-5922.12212

M3 - Article

VL - 34

SP - 423

EP - 430

JO - Cardiovascular Therapeutics

JF - Cardiovascular Therapeutics

SN - 0897-5957

IS - 6

ER -