title: Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter?
abstract: OBJECTIVE
  To assess the influence vulnerability and severity of cardiovascular disease (CVD), on prescription rates of secondary cardiovascular preventive drugs in old age.
  
  
  METHODS
  Population-based observational study within the ISCOPE study.
  
  
  METHODS
  General practices in the Netherlands.
  
  
  METHODS
  A total of 1350 patients with a history of CVD (median age 81 years, 50% female).
  
  
  METHODS
  One-year prescription rates of lipid-lowering drugs and antithrombotics were obtained from the electronic medical records of 46 general practitioners (GPs). Prescription of both drugs for ≥ 270 days per year was considered optimal. GPs made a judgement of vulnerability. Severity of CVD was expressed as major (myocardial infarction, stroke, or arterial surgery) versus minor (angina, transient ischaemic attack, or claudication).
  
  
  RESULTS
  GPs considered 411 (30%) participants to be vulnerable and 619 (55%) participants had major CVD. Optimal treatment was prescribed to 680 (50%) participants, whereas 370 (27%) received an antithrombotic drug only, 53 (4%) a lipid-lowering drug only, and 247 (18%) received neither. Optimal treatment was lower in participants aged ≥ 85 years (OR 0.37 [95% CI 0.29-0.48]), in females (OR 0.63 [0.50-0.78]), in vulnerable persons (OR 0.79 [0.62-0.99]) and in participants with minor CVD (OR 0.65 [0.53-0.81]). Multivariate ORs remained similar whereas vulnerability lost its significance (OR 0.88 [0.69-1.1]).
  
  
  CONCLUSIONS
  In old age, GPs' judgement of vulnerability is not independently associated with lower treatment rates of both lipid-lowering drugs and antithrombotics, whereas a history of minor CVD is. Individual proactive re-evaluation of preventive treatment in older (female) patients, especially those with a history of minor CVD, is recommended. Key points Prescriptions of lipid-lowering drugs and antithrombotics in secondary cardiovascular prevention tend to decline with age. In this study with median age 81 years, 50% of participants received optimal treatment with both lipid-lowering drugs and antithrombotics. GPs' judgement of vulnerability was not independently associated with optimal treatment. A history of less severe cardiovascular disease was independently associated with lower prescription rates of lipid-lowering drugs and antithrombotics. Proactive individual re-evaluation of cardiovascular preventive treatment in older (female) patients, especially patients with less severe cardiovascular disease, is recommended.
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Petra G
authors.initials: PG
authors.lastname: van Peet
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Jacobijn
authors.initials: J
authors.lastname: Gussekloo
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Wendy P J
authors.initials: WP
authors.lastname: den Elzen
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Jeanet W
authors.initials: JW
authors.lastname: Blom
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Margot W M
authors.initials: MW
authors.lastname: de Waal
authors.affiliation: a Department of Public Health and Primary Care , Leiden University Medical Center , Leiden , The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: de Ruijter
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006304:Health Status; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D057285:Precision Medicine; D055502:Secondary Prevention / Q000706:statistics & numerical data*; D012720:Severity of Illness Index
chemical_list: D000925:Anticoagulants; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents
keywords: Cardiovascular diseases; drug prescriptions; general practice; old age; secondary prevention; the Netherlands; vulnerability