Objective
To assess the influence vulnerability and severity of cardiovascular disease (CVD), on prescription rates of secondary cardiovascular preventive drugs in old age.
Design
Population-based observational study within the ISCOPE study.
Setting
General practices in the Netherlands.
Subjects
A total of 1350 patients with a history of CVD (median age 81 years, 50% female).
Main outcome measures
One-year prescription rates of lipid-lowering drugs and antithrombotics were obtained from the electronic medical records of 46 general practitioners (GPs). Prescription of both drugs for ≥ 270 days per year was considered optimal. GPs made a judgement of vulnerability. Severity of CVD was expressed as major (myocardial infarction, stroke, or arterial surgery) versus minor (angina, transient ischaemic attack, or claudication).
Results
GPs considered 411 (30%) participants to be vulnerable and 619 (55%) participants had major CVD. Optimal treatment was prescribed to 680 (50%) participants, whereas 370 (27%) received an antithrombotic drug only, 53 (4%) a lipid-lowering drug only, and 247 (18%) received neither. Optimal treatment was lower in participants aged ≥ 85 years (OR 0.37 [95% CI 0.29-0.48]), in females (OR 0.63 [0.50-0.78]), in vulnerable persons (OR 0.79 [0.62-0.99]) and in participants with minor CVD (OR 0.65 [0.53-0.81]). Multivariate ORs remained similar whereas vulnerability lost its significance (OR 0.88 [0.69-1.1]).
Conclusion
In old age, GPs’ judgement of vulnerability is not independently associated with lower treatment rates of both lipid-lowering drugs and antithrombotics, whereas a history of minor CVD is. Individual proactive re-evaluation of preventive treatment in older (female) patients, especially those with a history of minor CVD, is recommended. Key points Prescriptions of lipid-lowering drugs and antithrombotics in secondary cardiovascular prevention tend to decline with age. In this study with median age 81 years, 50% of participants received optimal treatment with both lipid-lowering drugs and antithrombotics. GPs’ judgement of vulnerability was not independently associated with optimal treatment. A history of less severe cardiovascular disease was independently associated with lower prescription rates of lipid-lowering drugs and antithrombotics. Proactive individual re-evaluation of cardiovascular preventive treatment in older (female) patients, especially patients with less severe cardiovascular disease, is recommended.
Overview publication
Title | Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter? |
Date | January 1st, 2015 |
Issue name | Scandinavian journal of primary health care |
Issue number | v33.4:260-8 |
DOI | 10.3109/02813432.2015.1117281 |
PubMed | 26683286 |
Authors | |
Keywords | Cardiovascular diseases, drug prescriptions, general practice, old age, secondary prevention, the Netherlands, vulnerability |
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