Pharmacological treatment after acute coronary syndrome: Baseline clinical characteristics and gender differences in a population-based cohort study / Tratamiento farmacológico después de un síndrome coronario agudo: características clínicas y diferencias de género en un estudio poblacional de cohortes

Objective: To describe baseline socio-demographic and clinical characteristics and drugs prescribed for secondary prevention after a first episode of ACS and to assess differences between men and women.SettingPHC in Catalonia. Data source: SIDIAP (Information System for Research in Primary Care).ParticipantsPatients who suffered an ACS during 2009–2016 and followed-up in PHC centres of the Catalan Health Institute in Catalonia.InterventionsNot applicable.Main measuresSocio-demographic and clinical characteristics at baseline: sex, age, socioeconomic index, toxic habits, comorbidities, study drugs (prescribed for cardiovascular secondary prevention: antiplatelets, betablockers, statins, drugs acting on the renin–angiotensin system) and comedications.Results8071 patients included, 71.3% of them were men and 80.2% had an acute myocardial infarction. Their mean age was 65.3 and women were older than men. The most frequent comorbidities were hypertension, dyslipidaemia and diabetes and they were more common in women. Antiplatelets (91.3%) and statins (85.7%) were the study drugs most prescribed. The uses of all comedications were significantly higher in women, except for nitrates. The combination of four study groups was initially prescribed in 47.7% of patients and combination of beta-blockers, statins and antiplatelets was prescribed in 18.4%. More men than women received all recommended pharmacological groups.ConclusionWomen were older, had more comorbidities and received more comedications. Most patients were treated with a combination of four or three study drugs for secondary prevention. Men initiated more drug treatments for secondary prevention and dual antiplatelet therapy than women.

Objetivos: Describir las características sociodemográficas y clínicas basales, y los fármacos prescritos para la prevención cardiovascular secundaria tras un síndrome coronario agudo (SCA). Analizar si existen diferencias entre varones y mujeres.EmplazamientoAtención primaria (AP) en Cataluña. Fuente de datos: Sistema de Información para el Desarrollo de la Investigación en AP (SIDIAP).ParticipantesPacientes que hayan sufrido un primer SCA durante 2009-2016, seguidos en AP del Instituto Catalán de la Salud en Cataluña.IntervencionesNo aplica.Mediciones principalesCaracterísticas sociodemográficas y clínicas al inicio: sexo, edad, índice socioeconómico, hábitos tóxicos, comorbilidades, fármacos de estudio (prescritos para prevención secundaria: antiagregantes, betabloqueantes, estatinas, fármacos del sistema renina-angiotensina) y fármacos concomitantes.ResultadosSe incluyeron 8.071 pacientes; 71,3% varones y 80,2% habían sufrido infarto. La edad media era de 65,3 años y las mujeres eran mayores que los varones. Las comorbilidades más frecuentes fueron hipertensión, dislipemia y diabetes; más comunes en mujeres. Antiagregantes (91,3%) y estatinas (85,7%) fueron los fármacos más prescritos. El uso de todas las comedicaciones era más frecuente en mujeres, excepto nitratos. La combinación de los 4 grupos farmacológicos de estudio se prescribió al 47,7% de los pacientes incluidos y la combinación de antiagregante, betabloqueante y estatina al 18,4%. Más varones que mujeres recibieron los fármacos recomendados.ConclusionesLas mujeres incluidas eran mayores, con más comorbilidad y mayor uso de comedicaciones. La mayoría de pacientes eran tratados con la combinación de 3 o 4 fármacos para prevención secundaria. Los varones iniciaban más fármacos para prevención secundaria y más terapia antiagregante doble que las mujeres.

Pharmacological treatment after acute coronary syndrome: Baseline clinical characteristics and gender differences in a population-based cohort study.

OBJECTIVE: To describe baseline socio-demographic and clinical characteristics and drugs prescribed for secondary prevention after a first episode of ACS and to assess differences between men and women. SETTING: PHC in Catalonia. DATA SOURCE: SIDIAP (Information System for Research in Primary Care). PARTICIPANTS: Patients who suffered an ACS during 2009-2016 and followed-up in PHC centres of the Catalan Health Institute in Catalonia. INTERVENTIONS: Not applicable. MAIN MEASURES: Socio-demographic and clinical characteristics at baseline: sex, age, socioeconomic index, toxic habits, comorbidities, study drugs (prescribed for cardiovascular secondary prevention: antiplatelets, betablockers, statins, drugs acting on the renin-angiotensin system) and comedications. RESULTS: 8071 patients included, 71.3% of them were men and 80.2% had an acute myocardial infarction. Their mean age was 65.3 and women were older than men. The most frequent comorbidities were hypertension, dyslipidaemia and diabetes and they were more common in women. Antiplatelets (91.3%) and statins (85.7%) were the study drugs most prescribed. The uses of all comedications were significantly higher in women, except for nitrates. The combination of four study groups was initially prescribed in 47.7% of patients and combination of beta-blockers, statins and antiplatelets was prescribed in 18.4%. More men than women received all recommended pharmacological groups. CONCLUSION: Women were older, had more comorbidities and received more comedications. Most patients were treated with a combination of four or three study drugs for secondary prevention. Men initiated more drug treatments for secondary prevention and dual antiplatelet therapy than women. EUPAS REGISTER: EUPAS19017.

Impact of adherence to drugs for secondary prevention on mortality and cardiovascular morbidity: A population-based cohort study. IMPACT study.

PURPOSE: Adherence to pharmacological therapy for secondary prevention after an acute coronary syndrome (ACS) reduces the risk of new cardiovascular events. However, several studies showed poor adherence. Our study aim was to assess the risk of a composite endpoint of major cardiovascular events (MACE) and all-cause mortality according to the adherence to these drugs in patients after an ACS in a primary health care cohort. METHODS: Population-based observational cohort study of patients with a first episode of ACS during 2009-2016. DATA SOURCE: Information System for Research in Primary Care (SIDIAP) database. Drug adherence was evaluated through proportion of days covered (PDC). RESULTS: We included 7152 patients and 5692 (79.6%) were adherent (PDC ≥ 75%) to the study drugs during the first year after the event. Adherents to any combination showed a significant reduction of the composite endpoint risk (HR 0.80 [0.73-0.88]), and a significant lower probability of the composite endpoint than nonadherents for all drugs, except beta-blockers. Adherents to 2 (HR 1.2; 95% CI 1.0-1.3) and 1 drug (HR 1.5; 95% CI 1.2-1.8) had higher composite endpoint risk compared to adherents to 4-3 drugs. CONCLUSION: Adherence to any combination of recommended drugs reduced the composite endpoint risk, regardless the number of drugs prescribed. Adherence to a combination of 4-3 drugs was significantly associated with a reduced mortality risk compared with adherents to 2 or 1, but it was not significant for MACE.

Impact of Medication Adherence on Mortality and Cardiovascular Morbidity: Protocol for a Population-Based Cohort Study.

BACKGROUND: Cardiovascular disease (CVD) is a group of disorders of the heart and blood vessels, such as coronary heart disease (CHD), cerebrovascular disease, and peripheral artery disease. CVD is the leading threat to global health, whether measured by mortality, morbidity, or economic cost. Long-term administration of aspirin, statins, beta-blockers, and angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers improves survival in patients with stablished coronary heart disease. Nevertheless, adherence to prescribed medication is poor for long-term drug treatment. OBJECTIVE: We aim to assess the relationship between adherences to the four pharmacological groups recommended for secondary prevention and the clinical outcomes of cardiovascular morbidity and mortality in patients with established CHD according to the level of adherence to these drugs in a population of incident cases of acute coronary syndrome (ACS). METHODS: Population-based cohort study of patients with a first episode of ACS during 2006-2015 in the Information System for Research in Primary Care (SIDIAP) database. We will estimate adherence to these drugs. The primary endpoint is a composite of all-cause mortality, ACS, and ischaemic stroke. Bivariate analyses will be performed estimating odds ratios for categorical variables and mean differences for continuous variables. Hazard ratios for adherences will be calculated for outcome events using Cox proportional hazard regression models, and proportionality of hazards assumption will be tested. RESULTS: We expect to estimate adherence to all four study treatments, the incidence of MACE, and to analyze if this incidence is associated with the level of drug adherence. CONCLUSIONS: We expect to find that adherent patients have a lower risk of the primary endpoints compared with nonadherent patients. TRIAL REGISTRATION: This study protocol was classified as EPA-OD by the AEMPS (IJG-EST-2017-01-2017-01, 07/04/2017) and registered in the EU PAS register (EUPAS19017, 09/05/2017).