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Thursday, January 29, 2015
1 MEDICATION THERAPY AT DISCHARGE FOR PATIENTS HOSPITALIZED WITH ACUTE MYOCARDIAL INFARCTION
Bulley E1, Cypro A1, Bechtold D1, Salvatierra G3, Daratha K2. 1University of Washington, Seattle, WA; 2Washington State University, Spokane, WA and 3Seattle University, Seattle, WA.
Purpose of Study: Secondary prevention of acute myocardial infarction (AMI) with guideline- recommended medications leads to improved outcomes and reduced health care costs. However, prescribing patterns at discharge for patients hospitalized with AMI are suboptimal, with elderly and female patients historically vulnerable to guideline-inconsistent prescribing. We aim to determine if advanced age and female gender remain factors in guideline- inconsistent prescribing.
Methods Used: This retrospective observational study examined administrative and discharge medication records for 1,699 Medicare-eligible patients hospitalized with a primary diagnosis of AMI from two hospitals in Washington between 2007 and 2011. Drugs from discharge medication summaries were classified electronically (ACE/ARBs, beta-blockers, statins, aspirin, and clopidogrel) to determine each patient’s prescription status for the five medication classes. Rates of nonprescription for each class were determined for both medically managed (MM) and revascularized (RV) patients. Binary logistic regression determined factors of nonprescription for each medication class.
Summary of Results: The mean age of the study sample was 76 and 60% of patients were male. MM patients (37%) were older and had more comorbidities than RV patients (63%). Nonprescription rates were high for each medication class (63% ACE/ARBS, 22% beta-blockers, 21% statins, 15% aspirin, and 40% clopidogrel) and are significantly higher among MM patients (40%, 26%, 31%, 22%, and 67%, respectively) than among RV patients (34%, 19%, 15%, 11%, and 24%, respectively). In fully adjusted models, advanced age predicted nonprescription of ACE/ARB for MM patients (OR=1.81) and female gender predicted nonprescription of statins for both MM (OR=1.69) and RV (OR=1.49) patients.
Conclusions: Use of guideline-recommended …
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