Tackling inequalities: are secondary prevention therapies for reducing post-infarction mortality used without disparities?. (February 2014)

• Record Type: Journal Article
• Authors: Buja, Alessandra; Boemo, Deris Gianni; Furlan, Patrizia; Bertoncello, Chiara; Casale, Patrizia; Baldovin, Tatjana; Marcolongo, Adriano; Baldo, Vincenzo
• Is Part Of: European journal of preventive cardiology. Volume 21:Number 2(2014)
• Page Start: 222
• Page End: 230
• Publication Date: 2014-02
• Subjects: Acute myocardial infarction -- angiotensin-converting enzyme inhibitors -- antiplatelet drugs -- beta-blocker -- coronary heart disease -- healthcare disparities -- medical therapy management -- omega-3 -- secondary prevention -- statins; Cardiovascular system -- Diseases -- Prevention -- Periodicals; Cardiac patients -- Rehabilitation -- Periodicals; 616.12
• DOI: 10.1177/2047487312462148
• Languages: English
• ISSNs: 2047-4873

Abstract

Background: Mortality due to coronary heart disease has been declining as a result of better clinical patient management, including secondary prevention with the aid of effective drugs. The clinical challenge remains how to improve adherence to evidence-based cardiac care for all patients who can benefit from it. The present study aimed to assess the effectiveness of drug use after acute myocardial infarction (AMI) in reducing total medium-term mortality and to establish whether there are disparities in prescribing all therapies of demonstrated effectiveness. Design: We conducted a retrospective cohort study between 2002 and 2009 using a record linkage database, considering 1327 patients discharged after AMI. Methods: Cox's regression models were used for the survival analysis with time-dependent variables. Logistic regression analyses were performed to investigate the inequalities in the actual use of therapies found significantly associated with a lower mortality in the survival analyses. Results: Therapies independently associated with a lower all-cause mortality risk were antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors, and statins. Gender-related differences in prescriptions were seen for statins and antiplatelet drugs; age-related differences emerged for all drugs. Associated chronic obstructive pulmonary disease reduced the likelihood of patients taking the effective treatments. Conclusion: The present study revealed disparities in the use of treatments for the secondary prevention of coronary heart disease unjustifiable on the strength of clinical evidence.