title: Secondary preventive medication use in a prevalent population-based cohort of acute coronary syndrome survivors.
abstract: OBJECTIVE
  Describe the dispensing patterns for guideline-recommended medications during 2008 in people with acute coronary syndrome (ACS) and how dispensing varies by gender and time since last ACS hospitalization.
  
  
  METHODS
  A descriptive cohort spanning 20 years of people alive post-ACS in 2008. We extracted all ACS hospitalizations and deaths in Western Australia (1989-2008), and all person-linked Pharmaceutical Benefits Scheme claims nationally for 2008. Participants were 23 642 men and women (36.8%), alive and aged 65-89 years in mid-2008 who were hospitalized for ACS between 1989 and 2008. Main outcome was the proportion of the study cohort (in 2008) dispensed guideline-recommended cardiovascular medications in that year. Adjusted odds ratios estimating the association between type (and number) of guideline-recommended medications and time since last ACS hospitalization.
  
  
  RESULTS
  Medications most commonly dispensed in 2008 were statins (79.6% of study cohort) and then angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACEi/ARBs) (71.1%), aspirin or clopidogrel (59.4%), and β-blockers (54.6%). Only 51.8% of the cohort was dispensed three or more of these drug types in 2008. Women with ACS were 18% less likely to be dispensed statins (adjusted odds ratio (OR)=0.82; 95% CI 0.76-0.88). Overall, for each incremental year since last ACS admission, there was an 8% increased odds (adjusted OR=1.08; 95% CI 1.07-1.08) of being dispensed fewer of the recommended drug regimen in 2008.
  
  
  CONCLUSIONS
  Longer time since last ACS admission was associated with dispensing fewer medications types and combinations in 2008. Interventions are warranted to improve dispensing long term and any apparent gender inequality in the drug class filled.
authors.affiliation: School of Population Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Anthony S
authors.initials: AS
authors.lastname: Gunnell
authors.affiliation: School of Population Health, The University of Western Australia, Perth, WA, Australia.|School of Medicine & Pharmacology, Sir Charles Gairdner Hospital Unit, The University of Western Australia, Perth, WA, Australia.
authors.forename: Joseph
authors.initials: J
authors.lastname: Hung
authors.affiliation: School of Population Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Matthew W
authors.initials: MW
authors.lastname: Knuiman
authors.affiliation: School of Population Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Lee
authors.initials: L
authors.lastname: Nedkoff
authors.affiliation: Centre for Epidemiology and Evidence, NSW Ministry of Health, Sydney, NSW, Australia.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Gillies
authors.affiliation: School of Population Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Geelhoed
authors.affiliation: School of Population Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Michael S T
authors.initials: MS
authors.lastname: Hobbs
authors.affiliation: Group A streptococcal and rheumatic heart diseases, Telethon Kids Institute, Perth, WA, Australia.
authors.forename: Judith M
authors.initials: JM
authors.lastname: Katzenellenbogen
authors.affiliation: Department of Cardiology, Fiona Stanley Hospital, Perth, WA, Australia.
authors.forename: Jamie M
authors.initials: JM
authors.lastname: Rankin
authors.affiliation: St Vincent's Clinical School, University of New South Wales, Sydney, NSW, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Ortiz
authors.affiliation: School of Population Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Tom G
authors.initials: TG
authors.lastname: Briffa
authors.affiliation: School of Population Health, The University of Western Australia, Perth, WA, Australia.
authors.forename: Frank M
authors.initials: FM
authors.lastname: Sanfilippo
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D016208:Databases, Factual; D011307:Drug Prescriptions; D004359:Drug Therapy, Combination; D005260:Female; D019983:Guideline Adherence / Q000639:trends; D054625:Healthcare Disparities; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000639:trends*; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods / Q000639:trends*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D014904:Western Australia / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents
keywords: Acute coronary syndrome; Evidence-based practice; Gender; Pharmacoepidemiology; Prevention and control