Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter?
Creators: name: Peet, Petra G. Van
name: Jacobijn Gussekloo
name: Elzen, Wendy P.J. Den
name: Blom, Jeanet W.
name: Waal, Margot W.M. De
name: Ruijter, Wouter De
Publisher: name: Taylor & Francis
Year: 2015
Subjects: subject: Medicine
subject: Neuroscience
subject: Pharmacology
subject: Biotechnology
subject: Science Policy
subject: 111714 Mental Health
subject: FOS: Health sciences
subject: FOS: Health sciences
subject: 60506 Virology
subject: FOS: Biological sciences
subject: FOS: Biological sciences
subject: Computational Biology

description: <i>Objective</i>: To assess the influence vulnerability and severity of cardiovascular disease (CVD), on prescription rates of secondary cardiovascular preventive drugs in old age. <i>Design:</i> Population-based observational study within the ISCOPE study. <i>Setting:</i> General practices in the Netherlands. <i>Subjects</i>: A total of 1350 patients with a history of CVD (median age 81 years, 50% female). <i>Main outcome measures.</i> 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). <i>Results</i>: 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]). <i>Conclusion</i>: 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 pointsPrescriptions 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. 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.