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

Figures & data

Table 1. Sociodemographics and clinical characteristics of participants with a history of cardiovascular disease from the ISCOPE study (n = 1350).

	n (%)
Sociodemographic
Age in years (median (interquartile range))	81 (78–85)
Male	678 (50)
GPs’ judgement of vulnerability^1
Vulnerable	411 (30)
Possibly or not vulnerable	927 (69)
Cardiovascular disease history^2
Severity
Minor cardiovascular disease^3	619 (46)
Major cardiovascular disease^4	731 (54)
Type of vascular bed
Cardiac	834 (62)
Angina	428 (32)
Myocardial infarction	377 (28)
Ischaemic heart disease	122 (9)
Cerebral	494 (37)
Transient ischaemic attack	246 (18)
Stroke	257 (19)
Peripheral	253 (19)
Intermittent claudication	195 (14)
Aneurysm	68 (5)
Cardiovascular preventive treatment with lipid-lowering or antithrombotic drugs
Type
Lipid-lowering drug^5	733 (54)
Antithrombotic drugs (aspirin or oral anticoagulant)	1050 (78)
Completeness of treatment
Optimal treatment: both lipid-lowering drug and antithrombotic drug^6	680 (50)
Suboptimal treatment: lipid-lowering drug only	53 (4)
Suboptimal treatment: anti-thrombotic drug only	370 (27)
Poor treatment: no lipid-lowering or antithrombotic drug	247 (18)

¹Assessed before screening (12 missing values); vulnerable participants versus possibly vulnerable (n = 360), not vulnerable (n = 513), or don’t know (n = 54); ²obtained from EMR general practitioners; ³history of angina, transient ischaemic attack, or intermittent claudication; ⁴history of myocardial infarction, stroke, or arterial surgery; ⁵use of statins (n = 1336) or other lipid-lowering drugs (n = 14); ⁶use of both drugs for more than 270 days during the first year of the ISCOPE study.

Figure 1. Optimal prescription rates (both lipid-lowering and antithrombotic drugs) depending on age, sex, GPs’ judgement of vulnerability, and severity of cardiovascular disease (n = 1350; p all < 0.05).

Table 2. Prescription rates (%) of lipid-lowering and/or antithrombotic drugs¹ in participants with a history of cardiovascular disease from the ISCOPE study (n = 1350).

	Age		Sex		Vulnerability^2		CVD history^3
	≥ 85	75–84	female	male	yes	no	minor	major
		(n = 347)	(n = 1003)	(n = 678)	(n = 672)	(n = 411)	(n = 927)	(n = 619)	(n = 731)
Optimal treatment (both drugs)	33	57^4	45	56^4	46	52^5	45	55^4
Suboptimal treatment
antithrombotic drug only	40	23^4	32	23^4	30	26^5	29	26
lipid-lowering drug only	2	5	5	3	3	4	5	3
Poor treatment (none of the two)	25	16^4	19	18	21	17	21	16^5

CVD: cardiovascular disease. ¹More than 270 days prescription of lipid-lowering and/or antithrombotic drugs in the year after start of ISCOPE study; ²assessed before screening (12 missing values); vulnerable (‘yes’) versus possibly vulnerable, not vulnerable participants, or do not know (together ‘no’); ³minor CVD: history of angina, transient ischaemic attack, and/or claudication; major CVD: history of myocardial infarction, stroke, and/or arterial surgery; ⁴Pearson’s chi-square p < 0.01 (as compared with ≥ 85 years, female, vulnerable or minor CVD, respectively); ⁵Pearson’s chi-square p < 0.05 (as compared with vulnerable, and as compared with minor CVD, respectively).

Table 3. Relation of age, sex, GPs’ judgement of vulnerability, and severity of cardiovascular disease with optimal¹ prescription rates of cardiovascular preventive treatment in participants with a history of cardiovascular disease from the ISCOPE study (n = 1350).

	Age ≥ 85 years		Female sex		Vulnerable^2		Minor CVD^3
	OR	95% CI	OR	95% CI	OR	95% CI	OR	95% CI
Univariate	0.37	0.29–0.48	0.63	0.50–0.78	0.79	0.62–0.99	0.65	0.53–0.81
Multivariate^4	0.39	0.30–0.50	0.71	0.57–0.89	0.88	0.69–1.1	0.67	0.53–0.83

CVD: cardiovascular disease. ¹Both lipid lowering and antithrombotic drug; ²patient considered vulnerable by their GP, 12 missing values; ³history of angina, transient ischaemic attack, or claudication without arterial surgery; ⁴adjusted for age, gender, vulnerability, and disease severity.