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Cardiovascular drug utilization and its determinants in unselected medical patients with ischemic heart disease

Andreas Spiess1, Malgorzata Roos, Roberto Frisullo

  • 1Division of Clinical Pharmacology and Toxicology, Department of Medicine, University Hospital, Zurich, Switzerland

European Journal of Internal Medicine
|February 12, 2002
PubMed

Insights

Secondary preventive drug use in ischemic heart disease (IHD) patients is common but has shortfalls. Opportunities exist to increase antithrombotic, beta-blocker, and lipid-lowering drug prescriptions, particularly in elderly patients and those not experiencing acute myocardial infarction.

Area of Science:

  • Cardiovascular Medicine
  • Pharmacoepidemiology
  • Clinical Pharmacy

Background:

  • Secondary preventive drug therapy significantly improves prognosis in patients with ischemic heart disease (IHD).
  • Understanding current drug utilization patterns and identifying gaps is crucial for optimizing patient outcomes.

Purpose of the Study:

  • To evaluate cardiovascular drug utilization in IHD patients.
  • To identify factors influencing the prescription of secondary preventive medications.
  • To determine the prevalence of underutilization for antithrombotic, beta-blocker, and lipid-lowering therapies.

Main Methods:

  • Prospective data collection from 987 medical inpatients with IHD across two Swiss teaching hospitals (1996-1998).
  • Pharmacoepidemiologic analysis of drug utilization at hospital discharge.
  • Assessment of shortfalls in key secondary preventive drug classes.

Main Results:

  • At discharge, only 64% received platelet aggregation inhibitors, 42% received beta-blockers, and 26% received lipid-lowering drugs.
  • Secondary preventive drugs were more common in acute myocardial infarction patients and less frequent in the elderly.
  • Shortfalls were noted in antithrombotic (6.5-8.3%) and beta-blocker use (9.9-23.3%); lipid-lowering drugs were underprescribed in hypercholesterolemic patients.

Conclusions:

  • While most IHD patients receive secondary preventive drugs, significant opportunities for increased utilization exist.
  • Targeted interventions are needed to improve prescribing rates in the elderly and non-acute myocardial infarction admissions.
  • Enhanced prescription of lipid-lowering drugs is recommended for patients with hypercholesterolemia.

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