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Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction

From the Institute for Clinical Evaluative Sciences (Austin, Tu, Ko, Alter); the Department of Public Health Sciences (Austin) and the Department of Health Management, Policy and Evaluation (Austin), University of Toronto; the Schulich Heart Centre and Division of Cardiology, Department of Medicine (Tu, Ko), Sunnybrook Health Sciences Centre; the Department of Medicine, Faculty of Medicine (Tu, Ko), University of Toronto; the Division of Cardiology and the Li Ka Shing Knowledge Institute (Alter), St. Michael's Hospital; The Cardiac and Secondary Prevention Program of the Toronto Rehabilitation Institute (Alter), Toronto, Ont.

Correspondence to: Dr. Peter C. Austin, Institute for Clinical Evaluative Sciences, Rm. G1 06, 2075 Bayview Ave., Toronto ON M4N 3M5; fax 416 480-6048; peter.austin{at}ices.on.ca

Background: Postdischarge use of evidence-based drug therapies has been proposed as a measure of quality of care for myocardial infarction patients. We examined trends in the use of evidence-based drug therapies after discharge among elderly patients with myocardial infarction.

Methods: We performed a cross-sectional study in a retrospective population-based cohort that was created using linked administrative databases. We included patients aged 65 years and older who were discharged from hospital with a diagnosis of myocardial infarction between Apr. 1, 1992, and Mar. 31, 2005. We determined the annual percentage of patients who filled a prescription for statins, β-blockers and angiotensin-modifying drugs within 90 days after discharge.

Results: The percentage of patients who filled a prescription for a β-blocker increased from 42.6% in 1992 to 78.1% in 2005. The percentage of patients who filled a prescription for an angiotensin-modifying drug increased from 42.0% in 1992 to 78.4% in 2005. The percentage of patients who filled a prescription for a statin increased from 4.2% in 1992 to 79.2% in 2005. In 2005, about half of the hospitals had rates of use for each of these therapies that were less than 80%. The temporal rate of increase in statin use after discharge was slower among noncardiologists than among cardiologists (3.5%–2.8% slower). The rate of increase was 4.8% slower for among physicians with low volumes of myocardial infarction patients than among those with high volumes of such patients and was 5.7% greater at teaching hospitals compared with nonteaching hospitals.

Interpretation: Use of statins, β-blockers and angiotensin-modifying drugs increased from 1992 to 2005. The rate of increase in the use of these medications after discharge varied across physician and hospital characteristics.

This article has been cited by other articles:

				M. L Johnson, L. A Petersen, R. Sundaravaradan, M. M Byrne, J. C Hasche, N. I Osemene, I. I Wei, and R. O Morgan The Association of Medicare Drug Coverage with Use of Evidence-Based Medications in the Veterans Health Administration Ann. Pharmacother., October 1, 2009; 43(10): 1565 - 1575. [Abstract] [Full Text] [PDF]

				J. Chen MD MPH and S.-L. T. Normand PhD Myocardial infarction and quality of care Can. Med. Assoc. J., October 21, 2008; 179(9): 875 - 876. [Full Text] [PDF]

				P. C. Austin PhD, J. V. Tu MD PhD, D. T. Ko MD MSc, and D. A. Alter MD PhD Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction Can. Med. Assoc. J., October 21, 2008; 179(9): 901 - 908. [Abstract] [Full Text] [PDF]

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