Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care.
OBJECTIVE
To determine if a gender or age bias exists in the prescription of important secondary preventive therapies for ischaemic heart disease in primary care.


METHODS
We identified 15 590 patients with ischaemic heart disease on the basis that they received a prescription for nitrate therapy over a 1-year period (September 1999 to August 2000) from the Eastern Region of the General Medical Services scheme in Ireland (population of 334 031), which provides free health service to those eligible patients in primary care. Odds ratios (OR) for the prescription of aspirin, beta-blockers, statins, calcium channel antagonists and ACE inhibitors in women and in those aged> 65 years were determined.


RESULTS
Female patients were less likely to receive a prescription for a beta-blocker [OR = 0.84, 95% confidence interval (CI) = 0.79, 0.89, P < 0.001], aspirin (OR = 0.72, 95% CI = 0.67, 0.78, P < 0.001), and ACE inhibitors (OR = 0.83, 95% CI = 0.78, 0.89, P < 0.001) compared with their male counterparts. However, women were more likely to receive anxiolytic benzodiazepines (OR = 1.71, 95% CI = 1.59, 1.85, P < 0.001) compared with their male counterparts. Elderly patients (aged> 65 years) were less likely to receive aspirin (OR = 0.92, 95% CI = 0.85, 0.99, P < 0.001), beta-blocker (OR = 0.66, 95% CI = 0.62, 0.71, P < 0.001) and a statin (OR = 0.5, 95% CI = 0.46, 0.53, P < 0.001).


CONCLUSIONS
An age and gender bias exists in the prescription of important secondary preventive therapies in primary care that may lead to increased mortality from ischaemic heart disease in these groups.
Williams
David
D
Department of Clinical Pharmacology, Aberdeen Royal Infirmary, Aberdeen, UK. david.j.williams@arh.grampian.scot.nhs.uk
Bennett
Kathleen
K
Feely
John
J
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000367:Age Factors; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D015982:Bias; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D002316:Cardiotonic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D017202:Myocardial Ischemia / Q000517:prevention & control*; D009566:Nitrates / Q000627:therapeutic use; D016017:Odds Ratio; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011320:Primary Health Care; D012737:Sex Factors
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D002121:Calcium Channel Blockers; D002316:Cardiotonic Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D009566:Nitrates; D010975:Platelet Aggregation Inhibitors; D001241:Aspirin