title: [Impact of a Decree on ACE inhibitors/ARBs in cardiovascular secondary prevention in the Lazio Region (Central Italy): a pre-post analysis].
abstract: OBJECTIVE
  to evaluate the effect of the 2010 legal decree (DCA) in the Lazio Region (Central Italy), promoting appropriateness on use of agents acting on the renin-angiotensin system, and limiting use of angiotensin II receptor blockers (ARBs) within this drug group to levels below 30%.
  
  
  METHODS
  two cohorts of incident patients with diagnosis of cardiovascular disease (CVD) were enrolled from the regional hospital information system: the first cohort included patients discharged during the 12 months before DCA (35,917 patients), and the second one patients discharged during the 12 months after DCA (35,491 patients).
  
  
  METHODS
  the first prescriptions of angiotensin- converting enzyme inhibitors (ACEIs) and ARBs in the 30 days after discharge were collected from the drug claims registry. The trends of monthly prescription proportions for the two drug groups were compared through a segmented regression analysis.
  
  
  METHODS
  comparison between the pre- and post-DCA periods, distinguishing between prescription made by hospital physicians and by general practitioners, and between naïve and prevalent users.
  
  
  RESULTS
  proportion of patients with CVD treated with ACEIs/ARBs after discharge was 50% in both pre-DCA (35,917 patients) and post-DCA (35,491 patients) cohorts, with the same share of ACEIs (60%) and ARBs (40%). ARB proportions met the threshold only for hospital prescriptions. Among naïve users, the target was met for both hospital physicians and general practitioners.
  
  
  CONCLUSIONS
  the specific DCA has not led to an overall improvement in the appropriateness of prescribing of ACEIs/ARBs in secondary cardiovascular prevention. However, there is a suitable prescription choice for naïve patients and when the drug is dispensed in hospital pharmacies.
authors: Dipartimento di epidemiologia, Sistema sanitario regionale del Lazio, Roma. f.mayer@deplazio.it.
authors: Flavia
authors: F
authors: Mayer
authors: Ursula
authors: U
authors: Kirchmayer
authors: Mirko
authors: M
authors: Di Martino
authors: Nera
authors: N
authors: Agabiti
authors: Danilo
authors: D
authors: Fusco
authors: Marina
authors: M
authors: Davoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality / Q000517:prevention & control*; D002423:Cause of Death; D003157:Community Pharmacy Services / Q000706:statistics & numerical data; D004363:Drug Utilization / Q000706:statistics & numerical data; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D058006:General Practice; D006801:Humans; D057970:Inappropriate Prescribing / Q000331:legislation & jurisprudence* / Q000517:prevention & control; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010607:Pharmacy Service, Hospital / Q000706:statistics & numerical data; D012044:Regression Analysis; D055502:Secondary Prevention / Q000331:legislation & jurisprudence*; D012959:Socioeconomic Factors; D055815:Young Adult
chemical_list: D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors