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Evidence‐based prescribing of drugs for secondary prevention of acute coronary syndrome in A boriginal and non‐ A boriginal patients admitted to W estern A ustralian hospitals
Author(s) -
Gausia K.,
Katzenellenbogen J. M.,
Sanfilippo F. M.,
Knuiman M. W.,
Thompson P. L.,
Hobbs M. S. T.,
Thompson S. C.
Publication year - 2014
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.12375
Subject(s) - medicine , confidence interval , acute coronary syndrome , odds ratio , aspirin , statin , medical record , diabetes mellitus , emergency medicine , myocardial infarction , endocrinology
Aims To assess the level of evidence‐based drug prescribing for acute coronary syndrome ( ACS ) at discharge from W estern A ustralian ( WA ) hospitals and determine predictors of such prescribing in A boriginal and non‐ A boriginal patients. Methods All Aboriginal (2002–2004) and a random sample of non‐Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA D ata L inkage S ystem. Clinical information, history of co‐morbidities and drugs were collected from medical notes by trained data collectors. Evidence‐based prescribing ( EBP ) was defined as prescribing of aspirin, statin and beta‐blocker or angiotensin‐converting enzyme inhibitor/angiotensin II antagonist. Results Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71%) had EBP , and there was no significant difference between A boriginal and non‐ A boriginal patients (70% vs 71%, P = 0.36). Conversely, a significantly higher proportion of A boriginal patients had none of the drugs prescribed compared with non‐ A boriginal patients (11% vs 7%, P < 0.01). EBP for ACS was independently associated with male sex (odds ratio ( OR ) 1.63, 95% confidence interval ( CI ) 1.26−2.11), previous admission for ACS ( OR 1.83, 95% CI 1.39–2.42) and diabetes ( OR 1.36, 95% CI 1.04–1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Conclusions Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both A boriginal and non‐ A boriginal patients. Attention regarding pharmaceutical management post‐ ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals.