Ten-year trends of cardiovascular drug use after myocardial infarction among community-dwelling persons > or =65 years of age.
Guidelines for post-myocardial infarction (MI) management emphasize treatment with statins, beta blockers (BBs), and angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). Little is known about the temporal trends and racial differences in such use after discharge. This study assessed temporal trends and racial differences in the use of statins, BBs, and ACEIs or ARBs after MI discharge in community-dwelling seniors. Administrative data from pharmacy assistance programs and Medicare in 2 states (1995 to 2004) were used to identify all patients hospitalized for MI who survived > or =90 days after discharge. Age, gender, race, co-morbidities, and MI-specific procedures during hospitalization were assessed. The study outcomes were filled prescriptions for any statin, BB, or ACEI or ARB <90 days after discharge. Multivariate regression was used for trend and racial difference analyses. Of 19,368 patients identified, 6,577 (34.0%) filled prescriptions for statins, 12,387 (64.0%) for BBs, and 9,934 (51.3%) for ACEIs or ARBs <90 days after MI discharge. The use of these drugs increased from 1995 to 2004, most steeply for statins (11% to 61%), less so for BBs (47% to 80%), and least for ACEIs or ARBs (46% to 58%) (all p for trend <0.001). Black patients were 14% and 5% less likely to receive statins and BBs, respectively (all p <0.05). No evidence of an interaction between race and time trend was found. In conclusion, the use of cardiovascular medications after discharge from MI hospitalization in older patients may still be inadequate but has increased over time. The underuse of statins and BBs was marked in black patients and did not improve over time.
Setoguchi
Soko
S
Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA. ssetoguchi@partners.org
Glynn
Robert J
RJ
Avorn
Jerry
J
Levin
Raisa
R
Winkelmayer
Wolfgang C
WC
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000208:ethnology*; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors