Evidence-based cardiovascular care in the community: a population-based cross-sectional study.
BACKGROUND
Ischaemic heart disease and congestive heart failure are common and important conditions in family practice. Effective treatments may be underutilized, particularly in women and the elderly. The objective of the study was to determine the rate of prescribing of evidence-based cardiovascular medications and determine if these differed by patient age or sex.


METHODS
We conducted a two-year cross-sectional study involving all hospitals in the province of Nova Scotia, Canada. Subjects were all patients admitted with ischaemic heart disease with or without congestive heart failure between 15 October 1997 and 14 October 1999. The main measure was the previous outpatient use of recommended medications. Chi-square analyses followed by multivariate logistic regression analyses were used to examine age-sex differences.


RESULTS
Usage of recommended medications varied from approximately 60% for beta-blockers and angiotensin converting enzyme (ACE) inhibitors to 90% for antihypertensive agents. Patients aged 75 and over were significantly less likely than younger patients to be taking any of the medication classes. Following adjustment for age, there were no significant differences in medication use by sex except among women aged 75 and older who were more likely to be taking beta-blockers than men in the same age group.


CONCLUSIONS
The use of evidence-based cardiovascular medications is rising and perhaps approaching reasonable levels for some drug classes. Family physicians should ensure that all eligible patients (prior myocardial infarction, congestive failure) are offered beta-blockers or ACE inhibitors.
Putnam
Wayne
W
Department of Family Medicine, Dalhousie University, Halifax, NS, Canada. wayne.putnam@dal.ca
Burge
Frederick I
FI
Lawson
Beverley
B
Cox
Jafna L
JL
Sketris
Ingrid
I
Flowerdew
Gordon
G
Zitner
David
D
D000368:Aged; D000553:Ambulatory Care / Q000639:trends; D002309:Cardiology / Q000639:trends; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D005194:Family Practice / Q000639:trends; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy*; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications / Q000188:drug therapy*; D009674:Nova Scotia
D002317:Cardiovascular Agents