Drug prescription rates in secondary cardiovascular prevention in old age: Do vulnerability and severity of the history of cardiovascular disease matter?

Abstract

Objective: To assess the influence vulnerability and severity of cardiovascular disease (CVD), on prescription rates of secondary cardiovascular preventive drugs in old age.

Design: Population-based observational study within the ISCOPE study. Setting: General practices in the Netherlands.

Subjects: A total of 1350 patients with a history of CVD (median age 81 years, 50% female).

Main outcome measures. One-year prescription rates of lipid-lowering drugs and antithrombotics were obtained from the electronic medical records of 46 general practitioners (GPs). Prescription of both drugs for ≥ 270 days per year was considered optimal. GPs made a judgement of vulnerability. Severity of CVD was expressed as major (myocardial infarction, stroke, or arterial surgery) versus minor (angina, transient ischaemic attack, or claudication).

Results: GPs considered 411 (30%) participants to be vulnerable and 619 (55%) participants had major CVD. Optimal treatment was prescribed to 680 (50%) participants, whereas 370 (27%) received an antithrombotic drug only, 53 (4%) a lipid-lowering drug only, and 247 (18%) received neither. Optimal treatment was lower in participants aged ≥ 85 years (OR 0.37 [95% CI 0.29–0.48]), in females (OR 0.63 [0.50–0.78]), in vulnerable persons (OR 0.79 [0.62–0.99]) and in participants with minor CVD (OR 0.65 [0.53–0.81]). Multivariate ORs remained similar whereas vulnerability lost its significance (OR 0.88 [0.69–1.1]).

Conclusion: In old age, GPs’ judgement of vulnerability is not independently associated with lower treatment rates of both lipid-lowering drugs and antithrombotics, whereas a history of minor CVD is. Individual proactive re-evaluation of preventive treatment in older (female) patients, especially those with a history of minor CVD, is recommended.

Key points

• Prescriptions of lipid-lowering drugs and antithrombotics in secondary cardiovascular prevention tend to decline with age.

• In this study with median age 81 years, 50% of participants received optimal treatment with both lipid-lowering drugs and antithrombotics.

• GPs’ judgement of vulnerability was not independently associated with optimal treatment.

• A history of less severe cardiovascular disease was independently associated with lower prescription rates of lipid-lowering drugs and antithrombotics.

• Proactive individual re-evaluation of cardiovascular preventive treatment in older (female) patients, especially patients with less severe cardiovascular disease, is recommended.

Keywords:

• Cardiovascular diseases
• drug prescriptions
• general practice
• old age
• secondary prevention
• the Netherlands
• vulnerability

Acknowledgements

Authors’ contributions: PGvP was responsible for study concept and design, analysed and interpreted data, drafted the manuscript, and did statistical analysis. JG was responsible for study concept and design, statistical analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. WPJdE was responsible for study concept and design, acquisition of data, statistical analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. JB was responsible for study concept and design, acquisition of data, statistical analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. MWMdW was responsible for study concept and design, acquisition of data, analysis and interpretation of data, and critical revision of the manuscript for important intellectual content. WdR was responsible for study concept and design, analysis and interpretation of data, and for critical revision of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

This study was funded by ZonMw, the Netherlands, Organization for Health Research and Development: ZonMw No. 311060201. The sponsor had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.