Hospital variation in use of secondary preventive medicine after discharge for first acute myocardial infarction during 1995-2004.
OBJECTIVE
To examine temporal trends in hospital use of secondary preventive medicine after discharge for first acute myocardial infarction (AMI) in Denmark.


METHODS
Observational study from national administrative databases of 60,339 patients who survived a first AMI at 73 acute-care hospitals during 1995-2004.


METHODS
At least 1 prescription claim for angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, or statins within 90 days of discharge for AMI.


RESULTS
The odds ratios between hospitals in the highest and lowest deciles, adjusted for age, gender, period, income, comorbidity, concomitant, and prior pharmaceutical therapy, in 1995 were 8.5 [95% confidence interval (CI), 5.5-12.2] for beta-blockers, 3.0 (2.3-3.7) for ACE inhibitors, and 6.2 (4.1-8.8) for statins. By 2004, the hospital variation had decreased for beta-blockers (3.2; 2.3-4.0) and statins (4.2; 3.0-5.5) but had increased for ACE inhibitors (3.8; 2.7-4.9). All the changes over time were significant (P < 0.001). Geographical characteristics of the hospital explained 32% of the variation in use of beta-blockers in 2004 and 27% in 1995, 39% of the variation in use of ACE inhibitors in 2004 and 3% in 1995, and 29% of the variation in use of statins and 19% in 1995.


CONCLUSIONS
Hospital use of secondary preventive medicine after discharge for AMI varied substantially. Hospital variation in use of beta-blockers and statins decreased with time whereas variation in use of ACE inhibitors increased. This may be attributed to gradually better agreement for the use of beta-blockers and statins and lesser agreement for the use of ACE inhibitors.
Rasmussen
Søren
S
National Institute of Public Health, Copenhagen, Denmark. sr@niph.dk
Abildstrom
Steen Z
SZ
Rasmussen
Jeppe N
JN
Gislason
Gunnar H
GH
Schramm
Tina K
TK
Folke
Fredrik
F
Køber
Lars
L
Torp-Pedersen
Christian
C
Madsen
Mette
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D003266:Continuity of Patient Care / Q000706:statistics & numerical data; D004363:Drug Utilization; D005260:Female; D006739:Hospital Administration; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D010351:Patient Discharge / Q000706:statistics & numerical data*; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013997:Time Factors
D002317:Cardiovascular Agents