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Research

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

Peter C. Austin, Jack V. Tu, Dennis T. Ko and David A. Alter
CMAJ October 21, 2008 179 (9) 895-900; DOI: https://doi.org/10.1503/cmaj.071481
Peter C. Austin PhD
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Jack V. Tu MD PhD
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Dennis T. Ko MD MSc
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David A. Alter MD PhD
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  • Résumé

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

    Peter C. Austin PhD, Jack V. Tu MD PhD, Dennis T. Ko MD MSc, David A. Alter MD PhD

    Contexte : Le recours à des traitements pharmacologiques fondés sur des preuves a été proposé comme mesure pour assurer la qualité des soins chez les patients qui reçoivent leur congé de l’hôpital après un infarctus du myocarde. Nous avons examiné les tendances relatives à l’utilisation des traitements pharmacologiques fondés sur des preuves après le congé de l’hôpital chez des patients âgés ayant subi un infarctus du myocarde.

    Méthodes : Nous avons effectué une étude transversale d’une cohorte rétrospective représentative qui a été cré�e à l’aide de bases de données administratives couplées. Nous avons inclus des patients âgés de 65 ans et plus qui ont reçu leur congé de l’hôpital avec un diagnostic d’infarctus du myocarde entre le 1er avril 1992 et le 31 mars 2005. Nous avons mesuré le pourcentage annuel de patients qui ont fait préparer des ordonnances de statines, de bêta-bloquants et d’agents modifiant l’angiotensine dans les 90 jours suivant leur congé.

    Résultats : Le pourcentage des patients ayant fait préparer une ordonnance de bêta-bloquants est passé de 42,6 % en 1992, à 78,1 % en 2005. Le pourcentage des patients ayant fait préparer une ordonnance d’agent modifiant l’angiotensine est passé de 42,0 % en 1992, à 78,4 % en 2005. Le pourcentage de patients ayant fait préparer une ordonnance de statine est passé de 4,2 % en 1992, à 79,2 % en 2005. En 2005, environ la moitié des hôpitaux affichaient des taux d’utilisation de chacun de ces traitements qui étaient inférieurs à 80 %. Le taux temporel d’augmentation de l’utilisation des statines après le congé a été plus lent chez les non-cardiologues que chez les cardiologues (3,5 % – 2,8 % plus lent). Le taux d’augmentation a été de 4,8 % plus lent chez les médecins présentant un faible volume de patients victimes d’infarctus du myocarde que chez ceux dont le volume de patients de ce type était important et a été de 5,7 % plus rapide dans les hôpitaux universitaires que dans les autres hôpitaux.

    Interprétation : L’utilisation de statines, de bêta-bloquants et d’agents modifiant l’angiotensine a augmenté entre 1992 et 2005. Le taux d’augmentation de l’utilisation de ces médicaments après le congé de l’hôpital variait selon les caractéristiques des médecins et des hôpitaux.

    Affiliations : 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.

    Correspondance : 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

  • Online Appendices

    Files in this Data Supplement:

    • Appendix 1: Rationale for using a 90-day window after discharge for filling a prescription and for combining angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers
    • Appendix 2: A) Increases in use of beta−blockers: 1992−2005

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Canadian Medical Association Journal: 179 (9)
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Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction
Peter C. Austin, Jack V. Tu, Dennis T. Ko, David A. Alter
CMAJ Oct 2008, 179 (9) 895-900; DOI: 10.1503/cmaj.071481

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Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction
Peter C. Austin, Jack V. Tu, Dennis T. Ko, David A. Alter
CMAJ Oct 2008, 179 (9) 895-900; DOI: 10.1503/cmaj.071481
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