TITLE

Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction

AUTHOR(S)
Austin, Peter C.; Tu, Jack V.; Ko, Dennis T.; Alter, David A.
PUB. DATE
October 2008
SOURCE
CMAJ: Canadian Medical Association Journal;10/21/2008, Vol. 179 Issue 9, p901
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Background: In an accompanying article, we report moderate between-hospital variation in the postdischarge use of β-blockers, angiotensin-modifying drugs and statins by elderly patients who had been admitted to hospital with acute myocardial infarction. Our objective was to identify the characteristics of patients, physicians, hospitals and communities associated with differences in the use of these medications after discharge. Methods: For this retrospective, population-based cohort study, we used linked administrative databases. We examined data for all patients aged 65 years or older who were discharged from hospital in 2005/06 with a diagnosis of myocardial infarction. We determined the effect of patient, physician, hospital and community characteristics on the rate of postdischarge medication use. Results: Increasing patient age was associated with lower postdischarge use of medications. The odds ratios (ORs) for a 1-year increase in age were 0.98 (95% confidence interval [CI] 0.97-0.99) for β-blockers, 0.97 (95% CI 0.97-0.98) for angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers and 0.94 (95% CI 0.93-0.95) for statins. Having a general or family practitioner, a general internist or a physician of another specialty as the attending physician, relative to having a cardiologist, was associated with lower postdischarge use of β-blockers, angiotensin-modifying agents and statins (ORs ranging from 0.46 to 0.82). Having an attending physician with 29 or more years experience, relative to having a physician who had graduated within the past 15 years, was associated with lower use of β-blockers (OR 0.71, 95% CI 0.60-0.84) and statins (OR 0.81, 95% CI 0.67-0.97). Interpretation: Patients who received care from noncardiologists and physicians with at least 29 years of experience had substantially lower use of evidence-based drug therapies after discharge. Dissemination strategies should be devised to improve the prescribing of evidence-based medications by these physicians.
ACCESSION #
34680832

 

Related Articles

  • Use of evidence-based therapies after discharge among elderly patients with acute myocardial infarction. Austin, Peter C.; Tu, Jack V.; Ko, Dennis T.; Alter, David A. // CMAJ: Canadian Medical Association Journal;10/21/2008, Vol. 179 Issue 9, p895 

    Background: Postdischarge use of evidence-based drug therapies has been proposed as a measure of quality of care for myocardial infarction patients. We examined trends in the use of evidence-based drug therapies after discharge among elderly patients with myocardial infarction. Methods: We...

  • Ritmos circadiano, circaseptano y circanual en el infarto agudo del miocardio. Ferrer Castro, Jacno E.; Corujo, Lianne Oliva; Ocejo, Marlene Fong; Castillo, Alejandro Rosell // MEDISAN;2013, Vol. 17 Issue 10, p1 

    A descriptive and cross-sectional study of 64 patients with acute myocardial infarction, assisted in "Dr. Joaquín Castillo Duany" Teaching Clinical Surgical Hospital in Santiago de Cuba was carried out during 2008, in order to determine the variability during cardiovascular events, with...

  • Gender Is a Predictor of Increased Mortality in Myocardial Infarction. Rose, Verna L.; Haley, John H. // American Family Physician;6/1/1999, Vol. 59 Issue 11, p3157 

    Presents an abstract of a study presented at the 48th Annual Session of the American College of Cardiology which showed that gender is an important predictor of mortality associated with acute myocardial infarction in patients.

  • Stents may be more beneficial for myocardial infarction.  // Modern Medicine;Sep98, Vol. 66 Issue 9, p30 

    Presents abstract of the articles `Randomized comparison of coronary stenting with balloon angioplasty in selected patients with acute myocardial infarction,' by H. Suryapranata, A.W.J. van't Hof, et al and `Primary stenting in acute myocardial infarction: the promise and the proof (editorial),'...

  • Equal care?  // Family Practice Management;Jun2000, Vol. 7 Issue 6, p25 

    Reports on a study published in the `Archives of Internal Medicine' periodical on how physicians manage their patients with acute myocardial infarction. Adjustment of data for severity and baseline measures.

  • An interventional strategy was better than a conservative strategy in unstable angina or non-ST-elevation MI. Hillegass, William B.; Brott, Brigitta C. // ACP Journal Club;Mar/Apr2003, Vol. 138 Issue 2, p32 

    Compares an interventional with a conservative strategy in patients with unstable angina or non-ST-elevation myocardial infarction in Europe. Background of the patients who participated in the study; Components of the two strategies; Application of the Randomized Intervention Trial of Unstable...

  • The Relation between Volume and Outcome in Health Care. Hannan, Edward L. // New England Journal of Medicine;05/27/99, Vol. 340 Issue 21, p1677 

    Editorial. Comments on the relation between hospitals with higher volume of specific surgical procedures and outcome in health care. Reference to a study in this issue by Thiemann et al examining the relationship between the number of elderly patients with acute myocardial infarction who are...

  • Is informed consent possible in acute myocardial infarction? Foëx, B. A. // Heart;Nov2004, Vol. 90 Issue 11, p1237 

    The article focuses on informed consent related to acute myocardial infarction (AMI) patients. In practice consent is valid if: the patient is competent; the patient is informed; and consent is freely given. Informed consent has been defined as an autonomous authorization by individuals of a...

  • Impact of specialty of admitting physician and type of hospital on care and outcome for myocardial infarction in England and Wales during 2004-5: observational study. Birkhead, John S.; Weston, Clive; Lowe, Derek // BMJ: British Medical Journal (International Edition);6/3/2006, Vol. 332 Issue 7553, p1306 

    Objective To examine process of care and outcome for patients admitted with acute myocardial infarction to hospitals in England and Wales in relation to type of consultant care and type of hospital. Design Observational study of 88 782 patients admitted with myocardial infarction during 2004-5,...

Share

Read the Article

Courtesy of VIRGINIA BEACH PUBLIC LIBRARY AND SYSTEM

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics