TY - JOUR
T1 - Guideline-based medications for older adults discharged after percutaneous coronary intervention in a suburban city of Japan
T2 - A cohort study using claims data
AU - Shimada, Koki
AU - Hamada, Shota
AU - Sawano, Mitsuaki
AU - Yamamoto, Hiroyuki
AU - Yoshie, Satoru
AU - Iijima, Katsuya
AU - Miyata, Hiroaki
N1 - Funding Information:
the present study. On the other hand, K.S., H.Y., and H.M. are also affiliated with the Department of Healthcare Quality Assessment at The University of Tokyo. The department is a social collaboration department supported by grants from the National Clinical Database, Johnson & Johnson K.K., and Nipro Corporation. K.S. reports receiving a portion of his salary from joint research funding by AstraZeneca K.K. of the JST-OPERA Program. M.S. received a grant from Takeda Japan Medical Office Funded Research Grant 2018 outside of the submitted work.
PY - 2020
Y1 - 2020
N2 - Secondary prevention with medications is essential for the better prognosis of patients who have experienced cardiovascular events. We aimed to evaluate the use of guideline-based medications for secondary prevention in older adults in the community settings after discharge following percutaneous coronary intervention (PCI). A retrospective cohort study was conducted using anonymized claims data of older beneficiaries in a suburban city of Japan between April 2012 and March 2015. The prescriptions of antiplatelets, statins, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB), and β-blockers were evaluated for 3 months before and after the month in which the participants underwent PCI. Multivariable logistic regression analysis was conducted to evaluate the associations of age (“pre-old” group [63-72 years] vs. “old” group [≥ 73 years]) and sex with the prescriptions, adjusting for whether a participant was followed-up by the PCI-performing hospital. Of 815 participants, 59.6% constituted the old group and 70.9% were men. The prescription rates for antiplatelets, statins, ACEi/ARB, and β-blockers after discharge were 94.6%, 65.0%, 59.3%, and 32.9%, respectively. The adjusted analysis indicated that statins were less likely to be prescribed for the old group (adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.51-0.95; p = 0.023) and for men (aOR, 0.64; 95% CI, 0.45-0.89; p = 0.008). β-blockers were more likely to be prescribed for men (aOR, 1.66; 95% CI, 1.17-2.33; p = 0.004). Our results suggest the potential for improvements in secondary prevention by increasing the prescription rates of guideline-based medications in this population.
AB - Secondary prevention with medications is essential for the better prognosis of patients who have experienced cardiovascular events. We aimed to evaluate the use of guideline-based medications for secondary prevention in older adults in the community settings after discharge following percutaneous coronary intervention (PCI). A retrospective cohort study was conducted using anonymized claims data of older beneficiaries in a suburban city of Japan between April 2012 and March 2015. The prescriptions of antiplatelets, statins, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB), and β-blockers were evaluated for 3 months before and after the month in which the participants underwent PCI. Multivariable logistic regression analysis was conducted to evaluate the associations of age (“pre-old” group [63-72 years] vs. “old” group [≥ 73 years]) and sex with the prescriptions, adjusting for whether a participant was followed-up by the PCI-performing hospital. Of 815 participants, 59.6% constituted the old group and 70.9% were men. The prescription rates for antiplatelets, statins, ACEi/ARB, and β-blockers after discharge were 94.6%, 65.0%, 59.3%, and 32.9%, respectively. The adjusted analysis indicated that statins were less likely to be prescribed for the old group (adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.51-0.95; p = 0.023) and for men (aOR, 0.64; 95% CI, 0.45-0.89; p = 0.008). β-blockers were more likely to be prescribed for men (aOR, 1.66; 95% CI, 1.17-2.33; p = 0.004). Our results suggest the potential for improvements in secondary prevention by increasing the prescription rates of guideline-based medications in this population.
KW - Claims data
KW - Coronary artery disease
KW - Elderly
KW - Percutaneous coronary intervention
KW - Secondary prevention
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U2 - 10.1620/tjem.252.143
DO - 10.1620/tjem.252.143
M3 - Article
C2 - 33028759
AN - SCOPUS:85092289907
VL - 252
SP - 143
EP - 152
JO - Tohoku Journal of Experimental Medicine
JF - Tohoku Journal of Experimental Medicine
SN - 0040-8727
IS - 2
ER -