Use of medicines recommended for secondary prevention of acute coronary syndrome

Abstract

OBJECTIVE : To analyze if the demographic and socioeconomic variables, as well as percutaneous coronary intervention are associated with the use of medicines for secondary prevention of acute coronary syndrome.METHODS : In this cohort study, we included 138 patients with acute coronary syndrome, aged 30 years or more and of both sexes. The data were collected at the time of hospital discharge, and after six and twelve months. The outcome of the study was the simultaneous use of medicines recommended for secondary prevention of acute coronary syndrome: platelet antiaggregant, beta-blockers, statins and angiotensin-converting-enzyme inhibitor or angiotensin receptor blocker. The independent variables were: sex, age, education in years of attending, monthly income in tertiles and percutaneous coronary intervention. We described the prevalence of use of each group of medicines with their 95% confidence intervals, as well as the simultaneous use of the four medicines, in all analyzed periods. In the crude analysis, we verified the outcome with the independent variables for each period through the Chi-square test. The adjusted analysis was carried out using Poisson Regression.RESULTS : More than a third of patients (36.2%; 95%CI 28.2;44.3) had the four medicines prescribed at the same time, at the moment of discharge. We did not observe any differences in the prevalence of use in comparison with the two follow-up periods. The most prescribed class of medicines during discharge was platelet antiaggregant (91.3%). In the crude analysis, the demographic and socioeconomic variables were not associated to the outcome in any of the three periods.CONCLUSIONS : The prevalence of simultaneous use of medicines at discharge and in the follow-ups pointed to the under-utilization of this therapy in clinical practice. Intervention strategies are needed to improve the quality of care given to patients that extend beyond the hospital discharge, a critical point of transition in care.

Prevalence of Cardioprotective Medication Use in Coronary Heart Disease Patients in South America: Systematic review and Meta-Analysis

“…From the publications included, 19 articles reported whether the prevalence of medication use was adequate. Half of them reported that medication use was low [ 59 62 76 77 78 ] or insufficient compared to guideline recommendations [ 2 12 48 61 79 ]. Other articles reported that cardioprotective medication use was adequate or high [ 32 60 66 67 73 75 ], or in line with guideline recommendations [ 38 65 80 ].…”

“…It was a common finding that prevalence of cardioprotective medication use was lower in women [ 2 12 48 77 ], and younger individuals [ 12 81 ]. For example, male patients had an OR ranging from 1.29, (95%CI 1.11–1.49) to 1.54 (95%CI 1.06 – 2.24) for statin use compared to females [ 12 77 ]; and patients aged 60 or older presented an OR ranging from 1.42 (95%CI,1.05–1.92) for the use of antiplatelet drugs [ 12 ] and 1.94 (1.07–3.50) for the use of cardioprotective medication in general [ 81 ].…”

“…A few articles identified the diagnosis category of CHD patients as determinant for medication use. Having a previous PCI was an independent determinant for higher use of antiplatelet drugs (OR 2.00, 95%CI 1.30–2.31) [ 2 ], and previous PCI or CABG were associated with higher use of statins (OR 2.37, 95%CI 2.07–2.72) [ 77 ]. One publication reported that patients who attended public centres (OR 1.99, 95%CI 1.54–2.59), or centres that are a combination of public and private (1.96, 95%CI 1.51–2.53) had higher odds of cardioprotective medication use compared to those attending private centres [ 3 ].…”

“…Lower SES [ 2 12 48 81 ] and living in rural areas [ 12 ] were also associated with lower medication use. In particular, participants from the wealthiest group had an OR of medication use of 2.54 (95%CI 1.08 – 5.95) for use of cardioprotective medication in general, to 5.94 (95%CI 2.80 – 12.6) for statin use compared to the least wealthy group [ 12 48 ]; and urban dwellers had an OR of 1.41 (95%CI 1.04–1.92) for use of ACEI/ARB compared to participants from a rural location [ 12 ].…”

“…Coronary heart disease (CHD) is the main cause of death and one of the most important causes of disability worldwide and in South America [ 1 ]. Cardioprotective medications, including antiplatelet, anti-hypertensive, lipid-lowering and hypoglycaemic medication, are effective in preventing CHD morbidity and mortality, [ 2 3 4 ] and their long-term use in patients with established CHD is recommended by international guidelines [ 2 5 ].…”