Secondary prevention after acute myocardial infarction in four Canadian provinces, 1997-2000

Louise Pilote, Christine A Beck, Igor Karp, David Alter, Peter Austin, Jafna Cox, Karin Humphries, Cynthia Jackevicius, Hugues Richard, Jack V Tu et al.
Canadian Journal of Cardiology 2004, 20 (1): 61-7

BACKGROUND: Publication of population-based analyses of medication use after acute myocardial infarction (AMI) could encourage the use of effective secondary prevention medications.

OBJECTIVE: To describe outpatient use of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, statins, calcium channel blockers and nitrates in elderly survivors of AMI over the fiscal years from 1997/98 to 1999/2000 in Nova Scotia, Quebec, Ontario and British Columbia.

METHODS: Linked administrative databases were used to identify all AMI patients 65 years of age or older admitted in Quebec (n=14,880), Ontario (n=28,647) and British Columbia (n=7549) over the study period, and to measure 90-day postdischarge utilization rates of cardiac medications for these patients. A population-based clinical registry was used to measure rates of prescription at discharge for elderly patients in Nova Scotia admitted to an acute care hospital from 1997 to 2000 (n=1997).

RESULTS: Utilization rates for beta-blockers, ACE inhibitors and statins increased over time, while rates for calcium channel blockers and nitrates decreased only slightly. The largest increases were for statins (Nova Scotia: 26% to 42%, Quebec: 27% to 43%; Ontario: 28% to 40%; British Columbia: 30% to 42%) and for ACE inhibitors in Ontario (55% to 65%) and Nova Scotia (46% to 68%). Of the three drugs recommended for secondary prevention, overall utilization rates for beta-blockers were highest in Nova Scotia, lowest in British Columbia, and similar in Quebec and Ontario. Rates for ACE inhibitors were highest in Ontario and similar in Quebec, Nova Scotia and British Columbia. Rates for statins were slightly higher in Quebec and British Columbia than in Ontario and Nova Scotia. The proportion of patients without a prescription for any of the recommended drugs was highest in British Columbia (20%), lowest in Nova Scotia (8%), and similar in Quebec and Ontario (Ontario: 12%; Quebec: 13%). There was marked regional variation in utilization rates within the four provinces.

CONCLUSIONS: Although utilization rates for recommended cardiac medications are increasing over time, there remains room for improvement. Overall utilization rates and temporal trends are generally similar in all four provinces, but there are wide regional variations within provinces.

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