학술논문
Quality of care for secondary cardiovascular disease prevention in 2009-2017: population-wide cohort study of antiplatelet therapy use in Scotland.
Document Type
Academic Journal
Author
Thalmann I; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK inna.thalmann@ndph.ox.ac.uk.; MRC Population Health Research Unit, Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.; Preiss D; MRC Population Health Research Unit, Clinical Trial Service Unit & Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.; Schlackow I; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.; Gray A; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.; Mihaylova B; Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.; Health Economics and Policy Research Unit, Wolfson Institute of Population Health, Queen Mary University of London, London, UK.
Source
Publisher: BMJ Pub. Group Country of Publication: England NLM ID: 101546984 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2044-5423 (Electronic) Linking ISSN: 20445415 NLM ISO Abbreviation: BMJ Qual Saf
Subject
Language
English
Abstract
Background: Antiplatelet therapy (APT) can substantially reduce the risk of further vascular events in individuals with established atherosclerotic cardiovascular disease (ASCVD). However, knowledge regarding the extent and determinants of APT use is limited.
Objectives: Estimate the extent and identify patient groups at risk of suboptimal APT use at different stages of the treatment pathway.
Methods: Retrospective cohort study using linked NHS Scotland administrative data of all adults hospitalised for an acute ASCVD event (n=150 728) from 2009 to 2017. Proportions of patients initiating, adhering to, discontinuing and re-initiating APT were calculated overall and separately for myocardial infarction (MI), ischaemic stroke and peripheral arterial disease (PAD). Multivariable logistic regression and Cox proportional hazards models were used to assess the contribution of patient characteristics in initiating and discontinuing APT.
Results: Of patients hospitalised with ASCVD, 84% initiated APT: 94% following an MI, 83% following an ischaemic stroke and 68% following a PAD event. Characteristics associated with lower odds of initiation included female sex (22% less likely than men), age below 50 years or above 70 years (aged <50 years 26% less likely, and aged 70-79, 80-89 and ≥90 years 21%, 39% and 51% less likely, respectively, than those aged 60-69 years) and history of mental health-related hospitalisation (45% less likely). Of all APT-treated individuals, 22% discontinued treatment. Characteristics associated with discontinuation were similar to those related to non-initiation.
Conclusions: APT use remains suboptimal for the secondary prevention of ASCVD, particularly among women and older patients, and following ischaemic stroke and PAD hospitalisations.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)
Objectives: Estimate the extent and identify patient groups at risk of suboptimal APT use at different stages of the treatment pathway.
Methods: Retrospective cohort study using linked NHS Scotland administrative data of all adults hospitalised for an acute ASCVD event (n=150 728) from 2009 to 2017. Proportions of patients initiating, adhering to, discontinuing and re-initiating APT were calculated overall and separately for myocardial infarction (MI), ischaemic stroke and peripheral arterial disease (PAD). Multivariable logistic regression and Cox proportional hazards models were used to assess the contribution of patient characteristics in initiating and discontinuing APT.
Results: Of patients hospitalised with ASCVD, 84% initiated APT: 94% following an MI, 83% following an ischaemic stroke and 68% following a PAD event. Characteristics associated with lower odds of initiation included female sex (22% less likely than men), age below 50 years or above 70 years (aged <50 years 26% less likely, and aged 70-79, 80-89 and ≥90 years 21%, 39% and 51% less likely, respectively, than those aged 60-69 years) and history of mental health-related hospitalisation (45% less likely). Of all APT-treated individuals, 22% discontinued treatment. Characteristics associated with discontinuation were similar to those related to non-initiation.
Conclusions: APT use remains suboptimal for the secondary prevention of ASCVD, particularly among women and older patients, and following ischaemic stroke and PAD hospitalisations.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY. Published by BMJ.)