Effect of age on the use of evidence-based therapies for acute myocardial infarction

Tran, Chau; Laupacis, Andreas; Mamdani, Muhammad; Tu, Jack V.

doi:10.1016/j.ahj.2003.11.028

Cited by 54 publications

(21 citation statements)

References 20 publications

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“…It is thought to be a result of several factors, including differences in symptom presentation, perceived risk of secondary events, concerns about limited information about the safety and effectiveness of these drugs in women, physician biases, and demographic factors, such as differences in age and socioeconomic status. 4,11,17,[26][27][28][29] There is a need for qualitative research on the reasons for underuse of evidencebased treatment among younger women.…”

Section: Treatment Initiationmentioning

confidence: 99%

“…We defined contraindications for the drugs as follows: (1) pregnancy at index hospitalization (all drugs), (2) asthma and nondrug-induced bradycardia (BBs), (3) cirrhosis (statins), and (4) renal failure and hyperkalemia (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers; see Table II in the Data Supplement for ICD-9 and ICD-10 codes). 17 Contraindications were identified using ICD-9 and ICD-10 diagnostic codes recorded at the index admission and during other hospital admissions and physician visits ≤1 year before index AMI.…”

Section: Pharmacotherapy Treatment Adherence and Optimal Therapymentioning

confidence: 99%

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Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

Smolina

Ball

Humphries

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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Background— The prevalence of the use of secondary prevention cardiovascular medications is lower among women than men, but it is unclear if this is a result of lower treatment initiation among women or lower treatment adherence. We aimed to map the treatment pathway for survivors of acute myocardial infarction (AMI) by sex and age. Methods and Results— This retrospective population-based cohort study used linked administrative data sets in British Columbia (2004–2011), which include health care, prescription drugs, sociodemographic, and mortality information. The study cohort included all individuals admitted to hospital for AMI in 2007–2009 and survived for 1 year after hospital discharge. Patients were evaluated for whether they initiated and then subsequently filled prescriptions angiotensin-converting enzyme inhibitors, β-blockers, and statins. More than two thirds of AMI survivors initiated treatment on all appropriate medications, given their contraindications, within 2 months of discharge. Younger men were significantly more likely than younger women to initiate appropriate treatment (adjusted odds ratio, 1.38; 95% confidence interval, 1.10–1.75). By the end of 1 year after discharge, only one third of all AMI survivors filled all appropriate prescriptions for at least 80% of the year. There was no significant difference in adherence to medication therapy between women and men. Conclusions— The majority of AMI survivors either discontinue treatment or do not refill their prescriptions consistently. Women <55 years are significantly less likely to be on optimal therapy by the end of 1 year after discharge, which is driven by a sex disparity in treatment initiation and not treatment adherence.

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Section: Treatment Initiationmentioning

confidence: 99%

Section: Pharmacotherapy Treatment Adherence and Optimal Therapymentioning

confidence: 99%

Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

Smolina

Ball

Humphries

et al. 2015

Circ: Cardiovascular Quality and Outcomes

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“…The percentage of patients receiving vitamin K antagonists decreased with age, particularly after the age of 70 years with the likelihood of receiving a vitamin K antagonist declined by 9.6% each year of age (Leizorovicz et al, 2007). Among all the studies from tier 1, 11 identified that the chronological age of a patient was an important factor affecting clinical decision-making (Bajorek et al, 2002;Dudley et al 2002;Hajjar et al, 2002;Peake et al, 2003;Woodard et al, 2003;Tran et al 2004;Avezum et al, 2005;Friberg et al, 2006;Harries et al, 2007;Kievit et al, 2010). The cut-off age influencing warfarin utilisation in older patients has ranged between 75 and 85 years (Bajorek et al, 2002;Waldo et al, 2005;DeWilde et al, 2006;Friberg et al, 2006;Bajorek and Ren, 2012).…”

Section: Underutilisation Of Medications and The Effect Of Age On Decmentioning

confidence: 95%

“…Studies have reported the underutilisation of diuretics (Hajjar et al, 2002), ␤-blockers (Dudley et al, 2002;Hajjar et al, 2002;Sloane et al, 2004;Tran et al, 2004;Avezum et al, 2005), statins (Avezum et al, 2005), angiotensin converting enzyme inhibitors (Sloane et al, 2004), aspirin (Dudley et al, 2002;Wright et al, 2009), antidepressants (Hanlon et al, 2011), calcium supplements (Sloane et al, 2004), and chemotherapy (Peake et al, 2003;Woodard et al, 2003), 8 studies specifically reported the underutilisation of warfarin in older patients (Bajorek et al, 2002;Simpson et al, 2005;Waldo et al, 2005;Leizorovicz et al, 2007;Gladstone et al, 2009;Perera et al, 2009;Bajorek and Ren, 2012). These studies reported that 15-21% of atrial fibrillation patients did not receive any anticoagulation therapy (Waldo et al, 2005;Gladstone et al, 2009), despite being at high risk of stroke and guideline recommendation, and in the absence of any contraindication to the therapy (Friberg et al, 2006;Gladstone et al, 2009; • In frail patients (older than non-frail patients), the likelihood to receive warfarin on hospitalisation and discharge from hospital decreased by 2.9 times (95% CI 1.5-6.0) and 8.6 times (95% CI 4.3-17.5) compared to non-frail patients Gladstone et al (2009) Analysis of data from a prospective database of stroke patients [•] • 39% of the AF patients (mean age 77 years) with a previous ischaemic stroke were using warfarin with subtherapeutic normalised ratio, • 15% were not using any antithrombotic medication Analysis of patient data from computerised medical records of general practitioners Bajorek and Ren, 2012).…”

Section: Underutilisation Of Medications and The Effect Of Age On Decmentioning

confidence: 99%

“…A total of 22 studies were identified (Table 1): nine studies pertained to hospital settings (Bajorek et al, 2002;Dudley et al, 2002;Peake et al, 2003;Tran et al, 2004;Avezum et al, 2005;Friberg et al, 2006;Perera et al, 2009;Wright et al, 2009;Bajorek and Ren, 2012); four studies were based in general practice (Simpson et al, 2005;DeWilde et al, 2006;Leizorovicz et al, 2007;; and three studies utilised disease-specific databases (e.g. disease-specific registries) (Woodard et al, 2003;Alibhai et al, 2004;Gladstone et al, 2009).…”

Section: Number and Type Of Studiesmentioning

confidence: 99%

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Pharmacotherapy in the ageing patient: The impact of age per se (A review)

Singh

Bajorek

2015

Ageing Research Reviews

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A literature search was carried out to review the influence of 'ageing' on pharmacotherapeutic decision-making, specifically how 'age' is defined and considered in the utilisation of medication. Embase, Medline, International Pharmaceutical Abstracts, and Google scholar were canvassed in a three-tiered search according to pre-established inclusion criteria. In tier 1, a total of 22 studies were identified highlighting the underutilisation of medication in elderly patients, with a particular focus on warfarin. Four studies highlighted an age-bias in medication-prescribing for elderly patients, specifically in relation to medicines for rheumatoid arthritis, angina, and hypertension. Tier 2 identified diverse definitions for 'elderly', including biological age, chronological age, physiological age, as well as various descriptions of 'elderly' in clinical trials and guidelines. Finally, medication optimisation tools were identified through the third tier, emphasising the use of chronological age to describe the 'elderly'. Old age influences pharmacotherapeutic decision-making at various levels, however, what complicates the situation is the absence of a comprehensive definition of 'elderly'. Clinical recommendations need to be based more on objective factors known to affect medication effectiveness and safety.

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The influence of age on clinical outcomes in patients treated with the resolute zotarolimus‐eluting stent

Belardi

Manoharan

Albertal

et al. 2015

Cathet Cardio Intervent

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Elderly patients undergoing PCI with a new-generation DES have increased mortality and bleeding risk, with similar rates of acute MI and repeat revascularization. Bleeding risk was higher in the elderly and strongly related to death. Target lesion failure rates were not significantly different between the two age groups, suggesting that the Resolute zotarolimus-eluting stent (R-ZES) is effective for patients younger and older than 70 years of age. R-ZES may be recommended for elderly patients when PCI with a DES is identified as a suitable option.

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Effect of age on the use of evidence-based therapies for acute myocardial infarction

Cited by 54 publications

References 20 publications

Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

Pharmacotherapy in the ageing patient: The impact of age per se (A review)

The influence of age on clinical outcomes in patients treated with the resolute zotarolimus‐eluting stent

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