[Medical management of patients with stable coronary artery disease in France in 2004. Data from the Mutualité Sociale Agricole].
OBJECTIVE
To describe the treatment of ambulatory patients with coronary artery disease, using information from the French farmers' insurance fund (Mutualité Sociale Agricole, MSA) database.


METHODS
Analysis of cardiovascular medications bought and reimbursed during the second quarter of 2004 for 16,694 patients affiliated with the MSA who were first diagnosed with coronary artery disease in 1998, 2001 or 2003.


RESULTS
On average, 71% of patients received antiplatelet agents, 56% beta-blockers, 59% statins, and 36% ACE inhibitors. Only 32% received the combination of antiplatelet agents, statins, and beta-blockers, and only 14% all four classes. Practice guidelines were followed more closely in patients diagnosed most recently. Patients receiving all four classes of secondary prevention medication more often has a history of myocardial infarction or were younger. Average doses were consistent with recommendations for beta-blockers, but appeared too low for ACE inhibitors and statins (except for atorvastatin).


CONCLUSIONS
Medical management of patients with chronic coronary artery disease in France, while still suboptimal, is improving. Our findings, which are concordant with previous registry data, emphasize the underuse of recognized secondary prevention medications in very elderly patients and the importance of the initial prescription at diagnosis.
Jeantet
Marine
M
Caisse centrale de la mutualité sociale agricole, Les Mercuriales, Bagnolet, Cedex, France. jeantet.marine@ccmsa.msa.fr
Gosselin
Sophie
S
Lefrand
Emeline
E
Hunold
Hervé
H
Vanbockstael
Vincent
V
Bertrand
Dominique
D
Danchin
Nicolas
N
D000319:Adrenergic beta-Antagonists / Q000009:adverse effects / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000628:therapy; D015331:Cohort Studies; D003327:Coronary Disease / Q000188:drug therapy / Q000628:therapy*; D003695:Delivery of Health Care / Q000592:standards; D004359:Drug Therapy, Combination; D005602:France; D006296:Health Services; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D012306:Risk
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors