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Socio‐demographic differences in adherence to evidence‐based drug therapy after hospital discharge from acute myocardial infarction: a population‐based cohort study in Rome, Italy
Author(s) -
Kirchmayer U.,
Agabiti N.,
Belleudi V.,
Davoli M.,
Fusco D.,
Stafoggia M.,
Arcà M.,
Barone A. P.,
Perucci C. A.
Publication year - 2012
Publication title -
journal of clinical pharmacy and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.622
H-Index - 73
eISSN - 1365-2710
pISSN - 0269-4727
DOI - 10.1111/j.1365-2710.2010.01242.x
Subject(s) - medicine , myocardial infarction , cohort , hospital discharge , drug , population , cohort study , emergency medicine , demography , pharmacology , environmental health , sociology
Summary What is known and Objective: Adherence to evidence‐based drug therapy after acute myocardial infarction has increased over the last decades, but is still unsatisfactory. Our objectives are to set out to analyse patterns of evidence‐based drug therapy after acute myocardial infarction (AMI), and evaluating socio‐demographic differences. Methods: A cohort of 3920 AMI patients discharged from hospital in Rome (2006–2007) was selected. Drugs claimed during the 12 months after discharge were retrieved. Drug utilization was defined as density of use (boxes claimed/individual follow‐up; chronic use = 6+ boxes/365 days) and therapeutic coverage, calculated through Defined Daily Doses (chronic use: ≥80% of individual follow‐up). Patterns of use of single drugs and their combination were described. The association between poly‐therapy and gender, age and socio‐economic position (small‐area composite index based on census data) was analysed through logistic regression, accounting for potential confounders. Results and Discussion: Most patients used single drugs: 90·5% platelet aggregation inhibitors (antiplatelets), 60·0%β‐blockers, 78·1% agents acting on the renin–angiotensin system (ACEIs/ARBs), 77·8% HMG CoA reductase inhibitors (statins). Percentages of patients with ≥80% of therapeutic coverage were 81·9% for antiplatelets, 17·8% for β‐blockers, 64·4% for ACEIs/ARBs and 76·1% for statins. The multivariate analysis showed gender and age differences in adherence to poly‐therapy (females: OR = 0·84; 95% CI 0·72–0·99; 71–80 years age‐group: OR = 0·82; 95% CI 0·68–0·99). No differences were observed with respect to socio‐economic position. What is new and Conclusion: The availability of information systems offers the opportunity to monitor the quality of care and identify weaknesses in public health‐care systems. Our results identify specific factors contributing to non‐adherence and hence define areas for more targeted health‐care interventions. Our results suggest that efforts to improve adherence should focus on women and older patients.