Factors associated with the discontinuation of evidence-based cardiovascular therapies in patients with stable coronary artery disease: a primary care perspective.
BACKGROUND
To identify factors associated with the discontinuation of evidence-based cardiovascular therapies after hospital discharge for a coronary event.


METHODS
Cross-sectional study carried out between June and October 2004 in 1799 primary care centers throughout Spain.


METHODS
Eight thousand eight hundred and seventeen patients (73.7% males; 65.4 years) admitted for coronary disease causes in the past 6 months to 10 years and attending primary care postdischarge from hospital. Current medications, those prescribed at hospital discharge, and the development of adverse events, new risk factors, and comorbidities during follow-up, were collected from clinical records.


RESULTS
After a median follow-up of 37.4 months, discontinuation rate of lipid-lowering agents, angiotensin renin system blockers, antiplatelet drugs, and beta-blockers were 7.2, 9.1, 10, and 20%, respectively. Of these, 10.8, 16.5, 9.9, and 20.1%, respectively, were because of adverse events. Factors associated with the discontinuation of lipid-lowering agents were the development of hypertension and diabetes during the follow-up. Discontinuation of antiplatelet drug was associated with an earlier history, or with de-novo occurrence, of atrial fibrillation. Discontinuation of angiotensin renin system blockers was associated with the development of atrial fibrillation, diabetes and hypercholesterolemia, and discontinuation of beta-blockers with de-novo appearance of peripheral artery disease, cerebrovascular disease, and heart failure.


CONCLUSIONS
In patients followed-up in primary care, the discontinuation rate of cardiovascular disease medications was low and was mainly related to the development of adverse events together with new risk factors and comorbidities arising after hospital discharge.
Mostaza
Jose M
JM
Atherosclerosis Unit, Hospital Carlos III, Bristol-Myers Squibb, Madrid, Spain. jmostaza.hciii@salud.madrid.org
Lahoz
Carlos
C
Martín-Jadraque
Raquel
R
Sanmartín
Miguel A
MA
Vicente
Ignacio
I
Tranche
Salvador
S
Taboada
Manuel
M
Mantilla
Teresa
T
Monteiro
Beatriz
B
Sanchez-Zamorano
Miguel Angel
MA
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000188:drug therapy* / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D004363:Drug Utilization; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011320:Primary Health Care; D013030:Spain / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors