Special articleSynergy between publication and promotion: comparing adoption of new evidence in Canada and the United States☆
Section snippets
Study selection
In brief, the HOPE study was a Canadian-led multinational trial involving 9297 patients at high risk of cardiovascular events; 26% of the study sites were in Canada (13). High risk was defined as age >55 years with vascular disease (e.g., coronary disease, stroke) or diabetes plus one additional risk factor (e.g., hypertension, dyslipidemia, microalbuminuria). The primary outcome was the composite of myocardial infarction, stroke, or cardiovascular death. The study was stopped early because of
Results
From 1998 through 2001, the total number of ACE inhibitors dispensed increased by 42% in Canada (from 8.1 to 11.5 million prescriptions per year) and by 22% in the United States (from 82.5 to 100.3 million prescriptions per year). Before publication of the HOPE study, prescribing of ramipril increased slowly in Canada, at a rate of 3% per month (Figure 1; P = 0.001); in the United States, the rate of increase was even slower, at 1% per month (P = 0.02).
The prerelease and publication of the HOPE
Discussion
We found that the prerelease and publication of the HOPE study was associated with a substantial increase in prescriptions for ramipril in Canada and the United States. These increases occurred as soon as the evidence became available. The rate of increase in the use of ramipril in Canada was twice that in the United States, and 1 year after the publication of the study ramipril accounted for 30% of all ACE inhibitors prescribed in Canada and 6% in the United States. In comparison, the rate of
Acknowledgements
We would like to thank IMS Health-Canada and IMS Health-America for providing us with unrestricted access to the data required for the analyses. We would also like to thank the IMS analysts in Canada (Dorothy Rhodes) and the United States (Adrienne Stanere) who collated and formatted the data, and in particular, Daria Parsons and Dr. John Sampalis of IMS Health-Canada for facilitating data access and providing comments on earlier versions of the manuscript.
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Drs. Majumdar and McAlister are Population Health Investigators supported by the Alberta Heritage Foundation for Medical Research, and New Investigators supported by the Canadian Institutes of Health Research. Dr. Soumerai is an Investigator in the HMO Research Network Center for Education and Research in Therapeutics, supported by the U.S. Agency for Healthcare Research and Quality (grant U18H510391) and the Harvard Pilgrim Health Care Foundation.