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Secondary prevention of coronary heart disease in older patients after the national service framework: population

Sheena E Ramsay1, Peter H Whincup, Debbie A Lawlor

  • 1Department of Primary Care and Population Sciences, Royal Free and University College Medical School, London NW3 2PF. s.ramsay@pcps.ucl.ac.uk

BMJ (Clinical Research Ed.)
|January 13, 2006
PubMed

Insights

Medication use for secondary prevention of coronary heart disease increased in older British adults, with significant gains in statin prescriptions. However, uptake of beta blockers and ACE inhibitors remains suboptimal, especially for angina patients.

Area of Science:

  • Cardiology
  • Geriatric Medicine
  • Public Health

Background:

  • Secondary prevention of coronary heart disease (CHD) is crucial for reducing recurrent events in older adults.
  • The National Service Framework aimed to improve CHD care in the UK.

Purpose of the Study:

  • To assess the uptake of secondary prevention medications for CHD in older British men and women.
  • To compare medication use before and after the implementation of the National Service Framework for CHD.

Main Methods:

  • Two population-based, longitudinal studies were conducted in 20 British towns.
  • Participants included men and women aged 60-79 with established CHD.
  • Prevalence of antiplatelet, statin, beta blocker, ACE inhibitor, and blood pressure-lowering drug use was assessed.

Main Results:

  • Between 1998-2001 and 2003, the use of all individual medications increased, notably statins.
  • Statin use rose from 34% to 65% in men and 48% to 67% in women with myocardial infarction.
  • Less than half of patients received beta blockers and ACE inhibitors by 2003, with lower use in angina patients compared to myocardial infarction patients.

Conclusions:

  • Statin uptake and combined drug treatment significantly increased in elderly patients between 1998-2001 and 2003.
  • Opportunities exist to further reduce recurrent CHD risk by improving medication uptake in angina patients.
  • Increased use of blood pressure-lowering treatments, particularly beta blockers and ACE inhibitors, is recommended.
Abstract

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