Evidence-based prescribing of drugs for secondary prevention of acute coronary syndrome in Aboriginal and non-Aboriginal patients admitted to Western Australian hospitals

• Published in: Internal medicine journal 2014-04, Vol.44 (4), p.353-361
• Main Authors: Gausia, K., Katzenellenbogen, J. M., Sanfilippo, F. M., Knuiman, M. W., Thompson, P. L., Hobbs, M. S. T., Thompson, S. C.
• Format: Article
• Language: English
• Subjects: Aboriginal; acute coronary syndrome; Acute Coronary Syndrome - ethnology; Acute Coronary Syndrome - prevention & control; Aged; discharge prescription; Drug Prescriptions - standards; Evidence-Based Medicine - methods; evidence-based prescribing; Female; Follow-Up Studies; Guideline Adherence; hospital; Humans; Male; Middle Aged; Morbidity - trends; Retrospective Studies; Secondary Prevention - methods; secondary preventive drugs; Western Australia; Western Australia - epidemiology
• ISSN: 1444-0903; 1445-5994; 1445-5994
• DOI: 10.1111/imj.12375

Aims To assess the level of evidence‐based drug prescribing for acute coronary syndrome (ACS) at discharge from Western Australian (WA) hospitals and determine predictors of such prescribing in Aboriginal and non‐Aboriginal patients. Methods All Aboriginal (2002–2004) and a random sample of non‐Aboriginal (2003) hospital admissions with a principal diagnosis of ACS were extracted from the WA Hospital Morbidity Data Collection of WA Data Linkage System. Clinical information, history of co‐morbidities and drugs were collected from medical notes by trained data collectors. Evidence‐based prescribing (EBP) was defined as prescribing of aspirin, statin and beta‐blocker or angiotensin‐converting enzyme inhibitor/angiotensin II antagonist. Results Records for 1717 ACS patients discharged alive from hospitals were reviewed. The majority of patients (71%) had EBP, and there was no significant difference between Aboriginal and non‐Aboriginal patients (70% vs 71%, P = 0.36). Conversely, a significantly higher proportion of Aboriginal patients had none of the drugs prescribed compared with non‐Aboriginal patients (11% vs 7%, P < 0.01). EBP for ACS was independently associated with male sex (odds ratio (OR) 1.63, 95% confidence interval (CI) 1.26−2.11), previous admission for ACS (OR 1.83, 95% CI 1.39–2.42) and diabetes (OR 1.36, 95% CI 1.04–1.79). However, ACS patients living in regional and remote areas, attending district or private hospitals, or with a history of chronic obstructive pulmonary disease were significantly less likely to have ACS drugs prescribed at discharge. Conclusions Opportunity exists to improve prescribing of recommended drugs for ACS patients at discharge from WA hospitals in both Aboriginal and non‐Aboriginal patients. Attention regarding pharmaceutical management post‐ACS is particularly required for patients from rural and remote areas, and those attending district and private hospitals.