title: Age and sex inequalities in the prescription of evidence-based pharmacological therapy following an acute coronary syndrome in Portugal: the EURHOBOP study.
abstract: OBJECTIVE
  To assess the proportion of patients receiving pharmacological therapy for secondary prevention after an acute coronary syndrome (ACS) in Portugal and to identify age and sex inequalities.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  We studied 747 episodes of ST-segment elevation myocardial infarction (STEMI) and 1364 of non-ST-segment elevation ACS (NSTE-ACS), within a sample of ACS cases consecutively discharged from 10 Portuguese hospitals, in 2008-2009. We estimated adjusted odds ratios (OR) for the association of age and sex with the use of each pharmacological treatment.
  
  
  RESULTS
  In STEMI and NSTE-ACS patients, the proportion of patients discharged with aspirin was 96 and 88%, clopidogrel 91 and 78%, aspirin+clopidogrel 88 and 71%, beta-blockers 80 and 76%, angiotensin-converting enzyme (ACE) inhibitors/ARB 82 and 80%, statins 93 and 90%, 3-drug (aspirin/clopidogrel+beta-blocker+statin) 76 and 69%, and 5-drug treatment (aspirin+clopidogrel+beta-blocker+ACE inhibitor/ARB+statin) 61 and 48%, respectively. Among STEMI patients, those aged ≥80 years were substantially less often discharged with clopidogrel (OR 0.22, 95% confidence interval, CI, 0.08-0.56), aspirin+clopidogrel (OR 0.34, 95% CI 0.15-0.76), beta-blockers (OR 0.39, 95% CI 0.18-0.82), 3-drug (OR 0.41, 95% CI 0.21-0.83), and 5-drug treatments (OR 0.44, 95% CI 0.23-0.83) than those <60 years; women were less likely to be discharged with aspirin+clopidogrel (OR 0.52, 95% CI 0.29-0.91). Among NSTE-ACS patients, those aged ≥80 years were much less likely to be discharged with beta-blockers (OR 0.58, 95% CI 0.36-0.93), statins (OR 0.35, 95% CI 0.19-0.64), and 3-drug treatment (OR 0.47, 95% CI 0.30-0.75); sex had no significant effect on treatment prescription.
  
  
  CONCLUSIONS
  The vast majority of younger patients were discharged on evidence-based secondary preventive medications, but only half received the 5-drug combination. Recommended therapies were substantially underprescribed in older patients.
authors.affiliation: Institute of Public Health of the University of Porto, Porto, Portugal martasfp@med.up.pt.
authors.forename: Marta
authors.initials: M
authors.lastname: Pereira
authors.affiliation: Institute of Public Health of the University of Porto, Porto, Portugal.
authors.forename: Carla
authors.initials: C
authors.lastname: Araújo
authors.affiliation: Centro Hospitalar de São João, Porto, Portugal.
authors.forename: Paula
authors.initials: P
authors.lastname: Dias
authors.affiliation: Institute of Public Health of the University of Porto, Porto, Portugal.
authors.forename: Nuno
authors.initials: N
authors.lastname: Lunet
authors.affiliation: Institut Hospital del Mar d`Investigacions Mèdiques, Barcelona, Spain.
authors.forename: Isaac
authors.initials: I
authors.lastname: Subirana
authors.affiliation: Institut Hospital del Mar d`Investigacions Mèdiques, Barcelona, Spain.
authors.forename: Jaume
authors.initials: J
authors.lastname: Marrugat
authors.affiliation: University of Liverpool, Liverpool, UK.
authors.forename: Simon
authors.initials: S
authors.lastname: Capewell
authors.affiliation: St James's Hospital, Dublin, Ireland.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Bennett
authors.affiliation: Institute of Public Health of the University of Porto, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Azevedo
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000188:drug therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D017723:Drug Utilization Review; D019317:Evidence-Based Medicine; D005260:Female; D019983:Guideline Adherence; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy*; D016017:Odds Ratio; D010351:Patient Discharge; D011174:Portugal; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012737:Sex Factors; D013997:Time Factors; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents
keywords: Acute coronary syndrome; age; inequalities; secondary prevention; sex