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Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction.
CMAJ. 2008 Oct 21; 179(9):895-900.CMAJ

Abstract

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, beta-blockers and angiotensin-modifying drugs within 90 days after discharge.

RESULTS

The percentage of patients who filled a prescription for a beta-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, beta-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.

Authors+Show Affiliations

Institute for Clinical Evaluative Sciences, Toronto, Ont. peter.austin@ices.on.caNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18936454

Citation

Austin, Peter C., et al. "Use of Evidence-based Therapies After Discharge Among Elderly Patients With Acute Myocardial Infarction." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 179, no. 9, 2008, pp. 895-900.
Austin PC, Tu JV, Ko DT, et al. Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction. CMAJ. 2008;179(9):895-900.
Austin, P. C., Tu, J. V., Ko, D. T., & Alter, D. A. (2008). Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 179(9), 895-900. https://doi.org/10.1503/cmaj.071481
Austin PC, et al. Use of Evidence-based Therapies After Discharge Among Elderly Patients With Acute Myocardial Infarction. CMAJ. 2008 Oct 21;179(9):895-900. PubMed PMID: 18936454.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction. AU - Austin,Peter C, AU - Tu,Jack V, AU - Ko,Dennis T, AU - Alter,David A, PY - 2008/10/22/pubmed PY - 2008/11/7/medline PY - 2008/10/22/entrez SP - 895 EP - 900 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 179 IS - 9 N2 - 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, beta-blockers and angiotensin-modifying drugs within 90 days after discharge. RESULTS: The percentage of patients who filled a prescription for a beta-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, beta-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. SN - 1488-2329 UR - https://www.unboundmedicine.com/medline/citation/18936454/Use_of_evidence_based_therapies_after_discharge_among_elderly_patients_with_acute_myocardial_infarction_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=18936454 DB - PRIME DP - Unbound Medicine ER -