Use of secondary preventive medications after the first attack of acute coronary syndrome.
BACKGROUND
It is not well-known to what extent evidence-based medications, such as beta-blockers, hypolipidemic medications, and angiotensin-converting enzyme inhibitors, are prescribed after an attack of acute coronary syndrome in the general healthcare setting and what is the compliance of patients with these prescriptions.


METHODS
We conducted a countrywide record linkage study.


METHODS
We used record linkage of the National Hospital Discharge Register, Causes of Death Register, and Social Insurance Institution's drug reimbursement records to identify drug purchases of patients aged 35-74 years hospitalized for the first nonfatal acute coronary syndrome in Finland during 1995-2003 (n=53 353).


RESULTS
In 2003 about 28 and 15% of the patients did not receive hypolipidemic medications or beta-blockers, respectively, after their acute coronary syndrome and a further 6 and 10% discontinued the use about 3 months later. Patients aged 65-74 years were less likely to receive hypolipidemic medications [odds ratio (OR) 0.55; 95% confidence interval (CI), 0.53-0.58] and beta-blockers (OR 0.77; 95% CI, 0.74-0.81) than younger patients. Diabetic patients received less hypolipidemic medications (OR 0.82; 95% CI, 0.78-0.86) and were more likely to discontinue the medication (OR 1.15; 95% CI, 1.05-1.26) than nondiabetic patients. In proportional hazards regression analyses the regular use of hypolipidemic medication or beta-blockers was associated with lower risk of cardiovascular death: adjusted hazard ratios 0.47 (95% CI, 0.41-0.53) and 0.54 (95% CI, 0.49-0.60), respectively.


CONCLUSIONS
Our study showed that the evidence-based use of medications after acute coronary syndrome was suboptimal in Finland, particularly in elderly and diabetic patients. Consistent use of these medications, however, was associated with a better prognosis.
Salomaa
Veikko
V
KTL-National Public Health Institute, Helsinki, Finland. veikko.salomaa@ktl.fi
Pääkkönen
Rauni
R
Hämäläinen
Helena
H
Niemi
Marja
M
Klaukka
Timo
T
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D003327:Coronary Disease / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010349:Patient Compliance / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012042:Registries / Q000706:statistics & numerical data; D012107:Research Design; D055502:Secondary Prevention; D013577:Syndrome; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents