title: Association between the use of 4 recommended drug categories and patient perceptions of health status following an ACS event.
abstract: BACKGROUND
  Four categories of medication have been shown to reduce mortality following an acute coronary syndrome (ACS) event: (a) antiplatelets, (b) beta-blockers, (c) statins, and (d) angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs).
  
  
  OBJECTIVE
  To determine the association between use of 1 or more of 4 categories of evidence-based medications and patient-perceived health status.
  
  
  METHODS
  Data from the registry of a large university-based health system were used for an analysis of prescribing at discharge following an inpatient hospitalization for ACS. Use of evidence-based medications and patientperceived health status were measured in a telephone survey administered 6 to 12 months (mean [SD] = 10 [3.5] months) after hospital discharge. Surveys were conducted from January 2002 through March 2005. Subjects were included in the survey if they were prescribed at least 1 of the 4 evidence-based drug categories at the time of discharge. Each patient was assigned to 1 of 5 groups (range: 0 to 4) based on the number of drug categories self-reported by the patient as current at the time of the survey. Patient-perceived health status was assessed using the question "How would you rate your health at the present time?" using a 5-point scale from excellent (1) to poor (5). Mean perceived health status scores for each of the 4 evidence-based medication categories were compared using Analysis of Variance (ANOVA). Multivariate logistic regression determined the association between patient-perceived health status-dichotomized to excellent/ very good/good versus fair/poor - and the evidence-based medication group, controlling for patient demographics and comorbidities. P values of < 0.05 were considered statistically significant.
  
  
  RESULTS
  A total of 393 of 1,206 patients (32.6%) responded to the survey between 6 and 12 months after discharge for an ACS event. The mean (SD) patient-perceived health status ranged from 3.3 (1.1) for patients with no (0) self-reported evidence-based medications (n = 14) to 2.5 (1.0) for patients with 4 evidence-based medications (n = 130, P = 0.028), indicating higher self-perceived health status for patients who were taking more of the evidence-based medications. Using patients with no (0) evidencebased medications as the comparator, the odds of higher patient-perceived health status were multiplied by 8.2 (95% confidence interval [CI] = 1.7- 37.9, P = 0.007) for those with 4 medications, 9.3 (95% CI = 2.0-43.4, P = 0.004) for those with 3 medications, 4.9 (95% CI = 1.1-22.6, P = 0.041) for those with 2 medications, and not significantly different for those with 1 medication (odds ratio = 2.5, 95% CI = 0.4-14.4, P = 0.316). Younger age, prior myocardial infarction, and recurrent ACS events occurring between discharge and the survey date were significantly associated with poorer perceived health status.
  
  
  CONCLUSIONS
  Better patient-perceived health status was associated with use of a greater number of evidence-based medications for patients with ACS.
authors.affiliation: University of Michigan, College of Pharmacy, 428 Church St., Ann Arbor, MI 48109-1065, USA. serick@umich.edu
authors.forename: Steven V
authors.initials: SV
authors.lastname: Erickson
authors.forename: Krishna
authors.initials: K
authors.lastname: Rangarajan
authors.forename: Eva M
authors.initials: EM
authors.lastname: Kline-Rogers
authors.forename: Dean E
authors.initials: DE
authors.lastname: Smith
authors.forename: Kim A
authors.initials: KA
authors.lastname: Eagle
mesh_terms: D054058:Acute Coronary Syndrome / Q000188:drug therapy*; D000367:Age Factors; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001294:Attitude to Health; D019317:Evidence-Based Medicine; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies
chemical_list: D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors