Abstract
Objective Despite the availability of various prevention guidelines on coronary artery disease, secondary prevention practice utilizing aspirin, beta-blockers, angiotensin converting enzyme inhibitors and statins still can be sub-optimal. In this study, we aimed to assess the guideline adherence of secondary prevention prescribing and the continuity of adherence for a 5-year period in a small cohort of patients angiographically diagnosed to have coronary artery disease. Method In this prospective study, 73 patients who were angiographically diagnosed to have CAD were followed up for 5 years. The baseline demographic and clinical data were collected just before angiography. The baseline drug data were collected at the day of discharge. The fifth year data were taken from the patients via face-to-face consultations or phone interviews. Results The ‘initial prescribing rate’ at discharge was found to be 82% for aspirin, 49% for statins, 44% for ACE inhibitors and 55% for beta-blockers. ‘Continuity of prescribing’ for 5 years was 45% for aspirin, 26% for statins, 17% for ACE inhibitors and 20% for beta-blockers. Conclusions Besides the sub-optimal prescribing of secondary prevention drugs, absence of continuity of prescribing seems to be a challenging issue in pharmaceutical care of coronary artery disease patients.
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References
AHA; ACC; National Heart, Lung, and Blood Institute, Smith SC Jr, Allen J, Blair SN, et al. AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung, and Blood Institute. J Am Coll Cardiol. 2006;47:2130–9.
Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Atherosclerosis. 2007;194:1–45.
Chinwong S, Reid F, McGlynn S, Hudson SA, Flapan AD. The need for pharmaceutical care in the prevention of coronary heart disease: an exploratory study in acute myocardial infarction patients. Pharm World Sci. 2004;26:96–101.
Reid F, Fossland B, Flapan AD, Duckelmann CC, Hudson SA. Evaluation of the implementation of a local treatment guideline in secondary prevention post-myocardial infarction. Pharm World Sci. 2001;23:177–8.
World Health Organization. World Health Organization: definition, diagnosis and classification of diabetes mellitus and its complications. Part I: diagnosis and classification of diabetes mellitus. Geneva, Switzerland: World Health Organization, 1999.
EUROASPIRE II study group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries; principal results from EUROASPIRE II Euro Heart Survey Programme. Eur Heart J. 2001;22:554–72.
Wahl C, Gregoire JP, Teo K, Beaulieu M, Labelle S, Leduc B, et al. Concordance, compliance and adherence in healthcare: closing gaps and improving outcomes. Healthc Q. 2005;8:65–70.
Montague T, Sidel J, Erhardt B, Nakhlé G, Caron L, Croteau D, et al. Patient health management: a promising paradigm in Canadian healthcare. Am J Manag Care. 1997;3:1175–82.
Jackevicius CA, Li P, Tu JV. Prevalence, predictors, and outcomes of primary nonadherence after acute myocardial infarction. Circulation. 2008;117:1028–36.
Al-Rashed SA, Wright DJ, Roebuck N, Sunter W, Chrystyn H. The value of inpatient pharmaceutical counselling to elderly patients prior to discharge. Br J Clin Pharmacol. 2002;54:657–64.
Cabana MD, Rand CS, Powe NR, Wu AW, Wilson MH, Abboud PA, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–65.
Bero LA, Grilli R, Grimshaw JM, Harvey E, Oxman AD, Thomson MA. Closing the gap between research and practice: an overview of systematic reviews of interventions to promote the implementation of research findings. BMJ. 1998;317:465–8.
Grimshaw JM, Thomas RE, MacLennan G, Fraser C, Ramsay CR, Vale L, et al. Effectiveness and efficiency of guideline dissemination and implementation strategies. Health Technol Assess. 2004;8(6):1–72.
Dirican RM. Community medicine courses (in Turkish). Ankara:Hatipoglu Yayinevi;1990. 1012.
Edirne T, Bloom P, Ersoy F. Update on family medicine in Turkey. Fam Med. 2004;36:311.
White EV. The development of the family prescription record system. J Am Pharm Assoc. 1973;13:357–9.
White EV, Latif DA. Reengineering pharmacotherapy delivery to maximize the role of the pharmacist and improve patient outcomes. Res Social Adm Pharm. 2007;3:223–35.
American Pharmaceutical Association. Principles of practice for pharmaceutical care. Washington, DC: American Pharmaceutical Association; 1995.
Paquette-Lamontagne N, McLean WM, Besse L, Cusson J. Evaluation of a new integrated discharge prescription form. Ann Pharmacother. 2001;35:953–8.
Kelly J, Forrest F, Hudson S. A patient-held medication record and a patient medication profile to support the continuity of acute cancer care. Int J Pharm Pract. 2001;9(suppl):R40.
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The study was carried out with no external funding.
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Apikoglu Rabus, S., Izzettin, F.V., Sancar, M. et al. Five-year follow-up of drug utilization for secondary prevention in coronary artery disease. Pharm World Sci 30, 753–758 (2008). https://doi.org/10.1007/s11096-008-9234-3
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DOI: https://doi.org/10.1007/s11096-008-9234-3