Missed opportunities in the secondary prevention of myocardial infarction: An assessment of the effects of statin underprescribing on mortality - 17/08/11
, Muhammad M. Mamdani, PharmD, MA, MPH a, c, f, David N. Juurlink, MD, PhD a, c, d, e, David A. Alter, MD, PhD a, c, g, Jack V. Tu, MD, PhD a, b, c, d, eRiassunto |
Background |
The benefits of statins for the secondary prevention of coronary heart disease are well established. Previous research indicates that patients at the greatest risk of cardiovascular events are the least likely to receive statins. We explored the potential reduction in mortality at the population level that could result from improving statin prescribing among patients least likely to be prescribed a statin after acute myocardial infarction (AMI).
Methods |
Simulation analysis of detailed clinical data for a population-based sample of 7285 AMI survivors discharged from 102 hospitals between April 1, 1999, and March 31, 2001 in Ontario, Canada, was done. Using estimates obtained from randomized controlled trials, we estimated the reduction in 3-year all-cause mortality associated with improved statin prescribing at hospital discharge.
Results |
Overall, 35.6% of patients received a statin prescription at hospital discharge. We estimate that increasing statin prescribing among patients least likely to receive them (ie, the lowest quintile of propensity to receive a prescription at discharge) from the current rate of 7.8% to the rate among all patients (35.6%) could decrease AMI mortality by 83 deaths in Ontario per year (2.1% of all post-AMI deaths within 3 years of discharge). Increasing statin prescribing to 70% among all patients with AMI could avert 312 deaths per year in Ontario. Factoring in low rates of adherence to statin therapy would reduce these estimates to 33 and 126, respectively.
Conclusions |
Modest increases in statin prescribing for patients least likely to receive one could decrease post-AMI mortality at the population level.
Il testo completo di questo articolo è disponibile in PDF.Mappa
| The Institute for Clinical Evaluative Sciences is supported in part by a grant from the Ontario Ministry of Health and Long-term Care. The opinions, results, and conclusions are those of the authors and no endorsement by the Ministry of Health and Long-term Care or by the Institute for Clinical Evaluative Sciences is intended or should be inferred. This research was supported in part by operating grants from the Canadian Institutes of Health Research (CIHR) and the Heart and Stroke Foundation to the Canadian Cardiovascular Outcomes Research Team. Drs Austin, Mamdani, and Juurlink are supported by New Investigator awards from the CIHR. Dr Juurlink is also supported by the University of Toronto Drug Safety Research Group. Dr Alter is supported by a New Investigator award from the CIHR and the Heart and Stroke Foundation. Dr Tu is supported by a Canada Research Chair in Health Services Research. |
Vol 151 - N° 5
P. 969-975 - Maggio 2006 Ritorno al numero
Articolo precedente
- 24-Hour ambulatory blood pressure monitoring
- J. Conor O'Shea, Robert M. Califf
- Achieving LDL cholesterol, non-HDL cholesterol, and apolipoprotein B target levels in high-risk patients: Measuring Effective Reductions in Cholesterol Using Rosuvastatin therapY (MERCURY) II
- Christie M. Ballantyne, Marcelo Bertolami, Hugo Ricardo Hernandez Garcia, Daniel Nul, Evan A. Stein, Pierre Theroux, Robert Weiss, Valerie A. Cain, Joel S. Raichlen
Benvenuto su EM|consulte, il riferimento dei professionisti della salute.
L'accesso al testo integrale di questo articolo richiede un abbonamento.
Già abbonato a @@106933@@ rivista ?