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Evidence-to-practice gaps in the management of community-dwelling Australian patients with ischaemic heart disease


Schmid, O and Chalmers, L and Bereznicki, L, Evidence-to-practice gaps in the management of community-dwelling Australian patients with ischaemic heart disease, Journal of Clinical Pharmacy and Therapeutics, 40, (4) pp. 398-403. ISSN 0269-4727 (2015) [Refereed Article]

Copyright Statement

Copyright 2015 John Wiley & Sons Ltd

DOI: doi:10.1111/jcpt.12274


What is known and objective: Ischaemic heart disease (IHD) is a major cause of death in developed countries. Patients with IHD are at greater risk of subsequent myocardial infarction (MI). International studies suggest that guideline recommended therapies proven to reduce this risk are underutilised. The objectives of this study were to review the use of guideline-recommended medications for the secondary prevention of IHD in Australians and identify patient characteristics influencing use of these medications.

Methods: The medication regimens of community dwelling Australians with documented IHD who received a Home Medicines Review (HMR) between January 2010 and September 2012 were extracted from a pharmacist decision support software database and retrospectively reviewed. Each patient's use of antithrombotics; angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs); statins; and β-blockers (BBs) or non-dihydropyridine calcium channel blockers (CCBs) was evaluated in conjunction with documented contraindications. Guideline concordance in all four categories was classified as 'Optimal Medical Therapy' (OMT). Univariate and multivariate analyses identified patient characteristics influencing OMT use.

Results and discussion: Of the 5396 patient medication regimens reviewed, 243% demonstrated OMT. Guideline concordance was observed in 916%, 756%, 748%, and 424% of patients for antithrombotics, statins, ACEI/ARBs, and BB/CCBs, respectively. The independent predictors of not receiving OMT were age 75 years or over (adjusted odds ratio [AOR] 076; 95% confidence interval [CI] 067-087), asthma (AOR 069; 95% CI 057-084), and depression or anxiety (AOR 084; 95% CI 071-099). Diabetes (AOR 120; 95% CI 104-138), hypertension (AOR 156; 95% CI 136-179) and a high Charlson Comorbidity Index score (AOR 137; 95% CI 115-164) independently predicted receipt of OMT.

What is new and conclusion: Only one quarter of community dwelling Australian patients with IHD receive antithrombotics, ACEI/ARBs, BB/CCBs and statins. The potential consequences of these evidence-to-practice gaps are exacerbated by Australia's increasing prevalence of IHD. Healthcare professionals must work to ensure that recommended therapies are prescribed and adhered to long-term, especially in the elderly and patients with asthma and mental health problems, to reduce IHD-related mortality and morbidity and the consequent healthcare and financial impact.

Item Details

Item Type:Refereed Article
Keywords:IHD, guideline, concordance, aging, angiotensin-converting enzyme inhibitor, anticoagulation, calcium channel blocker, coronary heart disease, guideline adherence, beta-blocker, statin
Research Division:Biomedical and Clinical Sciences
Research Group:Pharmacology and pharmaceutical sciences
Research Field:Clinical pharmacy and pharmacy practice
Objective Division:Health
Objective Group:Other health
Objective Field:Other health not elsewhere classified
UTAS Author:Schmid, O (Ms Olive Schmid)
UTAS Author:Chalmers, L (Dr Leanne Chalmers)
UTAS Author:Bereznicki, L (Professor Luke Bereznicki)
ID Code:100119
Year Published:2015
Web of Science® Times Cited:5
Deposited By:Pharmacy
Deposited On:2015-05-04
Last Modified:2017-11-24

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