Tags

Type your tag names separated by a space and hit enter

Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction.
CMAJ. 2008 Oct 21; 179(9):901-8.CMAJ

Abstract

BACKGROUND

In an accompanying article, we report moderate between-hospital variation in the postdischarge use of beta-blockers, angiotensin-modifying drugs and statins by elderly patients who had been admitted to hospital with acute myocardial infarction. Our objective was to identify the characteristics of patients, physicians, hospitals and communities associated with differences in the use of these medications after discharge.

METHODS

For this retrospective, population-based cohort study, we used linked administrative databases. We examined data for all patients aged 65 years or older who were discharged from hospital in 2005/06 with a diagnosis of myocardial infarction. We determined the effect of patient, physician, hospital and community characteristics on the rate of postdischarge medication use.

RESULTS

Increasing patient age was associated with lower postdischarge use of medications. The odds ratios (ORs) for a 1-year increase in age were 0.98 (95% confidence interval [CI] 0.97-0.99) for beta-blockers, 0.97 (95% CI 0.97-0.98) for angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers and 0.94 (95% CI 0.93-0.95) for statins. Having a general or family practitioner, a general internist or a physician of another specialty as the attending physician, relative to having a cardiologist, was associated with lower postdischarge use of beta-blockers, angiotensin-modifying agents and statins (ORs ranging from 0.46 to 0.82). Having an attending physician with 29 or more years experience, relative to having a physician who had graduated within the past 15 years, was associated with lower use of beta-blockers (OR 0.71, 95% CI 0.60-0.84) and statins (OR 0.81, 95% CI 0.67-0.97).

INTERPRETATION

Patients who received care from noncardiologists and physicians with at least 29 years of experience had substantially lower use of evidence-based drug therapies after discharge. Dissemination strategies should be devised to improve the prescribing of evidence-based medications by these physicians.

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

18936455

Citation

Austin, Peter C., et al. "Factors Associated With the Use of Evidence-based Therapies After Discharge Among Elderly Patients With Myocardial Infarction." CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, vol. 179, no. 9, 2008, pp. 901-8.
Austin PC, Tu JV, Ko DT, et al. Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction. CMAJ. 2008;179(9):901-8.
Austin, P. C., Tu, J. V., Ko, D. T., & Alter, D. A. (2008). Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction. CMAJ : Canadian Medical Association Journal = Journal De l'Association Medicale Canadienne, 179(9), 901-8. https://doi.org/10.1503/cmaj.080295
Austin PC, et al. Factors Associated With the Use of Evidence-based Therapies After Discharge Among Elderly Patients With Myocardial Infarction. CMAJ. 2008 Oct 21;179(9):901-8. PubMed PMID: 18936455.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Factors associated with the use of evidence-based therapies after discharge among elderly patients with 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 - 901 EP - 8 JF - CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne JO - CMAJ VL - 179 IS - 9 N2 - BACKGROUND: In an accompanying article, we report moderate between-hospital variation in the postdischarge use of beta-blockers, angiotensin-modifying drugs and statins by elderly patients who had been admitted to hospital with acute myocardial infarction. Our objective was to identify the characteristics of patients, physicians, hospitals and communities associated with differences in the use of these medications after discharge. METHODS: For this retrospective, population-based cohort study, we used linked administrative databases. We examined data for all patients aged 65 years or older who were discharged from hospital in 2005/06 with a diagnosis of myocardial infarction. We determined the effect of patient, physician, hospital and community characteristics on the rate of postdischarge medication use. RESULTS: Increasing patient age was associated with lower postdischarge use of medications. The odds ratios (ORs) for a 1-year increase in age were 0.98 (95% confidence interval [CI] 0.97-0.99) for beta-blockers, 0.97 (95% CI 0.97-0.98) for angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers and 0.94 (95% CI 0.93-0.95) for statins. Having a general or family practitioner, a general internist or a physician of another specialty as the attending physician, relative to having a cardiologist, was associated with lower postdischarge use of beta-blockers, angiotensin-modifying agents and statins (ORs ranging from 0.46 to 0.82). Having an attending physician with 29 or more years experience, relative to having a physician who had graduated within the past 15 years, was associated with lower use of beta-blockers (OR 0.71, 95% CI 0.60-0.84) and statins (OR 0.81, 95% CI 0.67-0.97). INTERPRETATION: Patients who received care from noncardiologists and physicians with at least 29 years of experience had substantially lower use of evidence-based drug therapies after discharge. Dissemination strategies should be devised to improve the prescribing of evidence-based medications by these physicians. SN - 1488-2329 UR - https://www.unboundmedicine.com/medline/citation/18936455/Factors_associated_with_the_use_of_evidence_based_therapies_after_discharge_among_elderly_patients_with_myocardial_infarction_ L2 - http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=18936455 DB - PRIME DP - Unbound Medicine ER -