Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction

Institute for Clinical Evaluative Sciences, Toronto, Ont.
Canadian Medical Association Journal (Impact Factor: 5.96). 11/2008; 179(9):895-900. DOI: 10.1503/cmaj.071481
Source: PubMed


Postdischarge use of evidence-based drug therapies has been proposed as a measure of quality of care for myocardial infarction patients. We examined trends in the use of evidence-based drug therapies after discharge among elderly patients with myocardial infarction.
We performed a cross-sectional study in a retrospective population-based cohort that was created using linked administrative databases. We included patients aged 65 years and older who were discharged from hospital with a diagnosis of myocardial infarction between Apr. 1, 1992, and Mar. 31, 2005. We determined the annual percentage of patients who filled a prescription for statins, beta-blockers and angiotensin-modifying drugs within 90 days after discharge.
The percentage of patients who filled a prescription for a beta-blocker increased from 42.6% in 1992 to 78.1% in 2005. The percentage of patients who filled a prescription for an angiotensin-modifying drug increased from 42.0% in 1992 to 78.4% in 2005. The percentage of patients who filled a prescription for a statin increased from 4.2% in 1992 to 79.2% in 2005. In 2005, about half of the hospitals had rates of use for each of these therapies that were less than 80%. The temporal rate of increase in statin use after discharge was slower among noncardiologists than among cardiologists (3.5%-2.8% slower). The rate of increase was 4.8% slower for among physicians with low volumes of myocardial infarction patients than among those with high volumes of such patients and was 5.7% greater at teaching hospitals compared with nonteaching hospitals.
Use of statins, beta-blockers and angiotensin-modifying drugs increased from 1992 to 2005. The rate of increase in the use of these medications after discharge varied across physician and hospital characteristics.

12 Reads
  • Source
    • "Unfortunately, literature search shows paucity of data in terms of healthcare professionals’ role in both diagnosis and management of disease. This is evident from the fact that treatment rate for osteoporosis differs significantly from other medical conditions such as myocardial infarction for which 75% of patients receive appropriate treatment while only 10% of osteoporotic patients would receive adequate treatment (Giangregorio & Papaioannou 2006; Austin & Tu 2008). The reason for poor treatment rate of osteoporosis is attributed to the fact that unless a bone scan is done, it is impossible to diagnose osteoporosis. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The objective of the current study is to analyze different approaches of pharmacists and general practitioners towards availability and use of osteoporosis prescreening tools and to find out reasons that explain non utilization of such tools in clinical practice. Among General practitioners and Community pharmacists in Pulau Penang, Malaysia. An explorative cross sectional study was carried out using convenience sampling approach. A pre-validated self- administered questionnaire was used to carry out the study. A total of 170 healthcare professionals participated in study. Evaluation of awareness, use and opinions of healthcare professionals regarding osteoporosis prescreening tools. Response rate of study was 56%. The mean age of the participants was 39.00 + 7.89 years. Less than one third of participants were familiar with term prescreening tools or Clinical decision rules. The only osteoporosis prescreening tool that was recognized and used by majority of participants was FRAX. Participants agreed that low level of awareness regarding availability of prescreening tools poses hindrance in utilization of such tools in clinical practice. Majority of participants showed willingness to gain information and use such tools in future. The results of our study demonstrate an urgent need of implementation of osteoporosis prescreening tools educational and awareness programs among healthcare professionals.
    SpringerPlus 09/2013; 2(1):463. DOI:10.1186/2193-1801-2-463
  • Source
    • "Guidelines recommend the combined use of all four medicines as each of these agents has been shown to reduce the risk of death and reinfarction8–10, and combination use provides the largest reduction in risk11. Despite these guidelines, we know that not all eligible AMI patients receive these pharmacotherapies12,13. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Previous research has shown a socioeconomic status (SES) gradient in the receipt of cardiac services following acute myocardial infarction (AMI), but much less is known about SES and the use of secondary preventive medicines following AMI. To examine the role of income in initiation of treatment with ACE-inhibitors, beta-blockers and statins in the 120 days following discharge from hospital for first AMI. A cross-sectional study with a population-based cohort. First-time AMI patients between age 40 and 100 discharged alive from the hospital and surviving at least 120 days following discharge between January 1, 1999 and September 3, 2006. Binary variables indicating whether the patient had filled at least one prescription for each of the medicines of interest. Our results reveal a significant and positive income gradient with initiation of the guideline-recommended medicines among male AMI patients. Men in the third income quintile and above were significantly more likely to initiate treatment with any of the medicines than those in the first quintile, with those in the fifth income quintile having 37%, 50% and 71% higher odds of initiating ACE-inhibitors, beta-blockers and statins, respectively, than men in the lowest income quintile [OR = 1.37 95% CI (1.24, 1.51); OR = 1.50 95% CI (1.35, 1.68); and OR = 1.71 95% CI (1.53, 190)]. The gradient was not present among women, although women in the fifth income quintile were more likely to initiate beta-blockers and statins than women in the lowest income quintile [OR = 1.25 95% CI (1.06, 1.47) and OR = 1.32 95% CI (1.12, 1.54)]. There were inequities in treatment following AMI in the form of a clear and often significant gradient between income and initiation of evidence-based pharmacologic therapies among male patients. This gradient persisted despite significant changes in coverage levels for the costs of these medicines.
    Journal of General Internal Medicine 07/2011; 26(11):1329-35. DOI:10.1007/s11606-011-1799-1 · 3.42 Impact Factor
  • Source

    Canadian Medical Association Journal 11/2008; 179(9):875-6. DOI:10.1503/cmaj.081438 · 5.96 Impact Factor
Show more


12 Reads
Available from