Use of evidence-based therapy for the secondary prevention in patients with coronary artery disease in Palestinian practices

Supervisor:

Dr. Samah Al-Jabi

Abstract :

Introduction: Secondary prevention medications of coronary artery disease (CAD) have been found to be beneficial in reducing the incidence of recurrent cardiac events and improve the quality of life

Objectives of the study: the main objectives of this study were to examine the use of evidence-based secondary prevention medications among patients with CAD according to the American guidelines and to investigate the relationship between the adherence to evidence-based secondary prevention guideline and various demographic and clinical variables.

Methods: A four-month period cross sectional study that included CAD patients over 18 years old was done. Information was gathered from face to face interviews as well as patients' records. A data collection form concerning the medications that they were prescribed (mainly antiplatelet, beta blockers “β-blockers”, statin, angiotension converting enzyme (ACE) inhibitor / angiotension receptor antagonist)  and the extent of patients’ adherence to these medications, as well as the other demographic and clinical characteristics were included.

Results: Over 4 months period of data collection, 263 CAD patients were adopted, 41.1% of them suffered from MI, 33.5% of them had angina, 22.8% with unstable angina, and (2.7%) were diagnosed with vasospastic angina. Results showed that the disease was more prevalent in males than females (2.1:1) ratio. In terms of prescribing pattern and adherence to guidelines, aspirin was prescribed to 93.9% of patients, 84.4% for statin, 49.4% for beta blockers, 31.9% for clopidogrel, 29.3% for ACE-inhibitors, and 5.3% for ARBs. Patients adherence to both aspirin and statins was measured with 27% of all patients being highly adherent to aspirin; and 37% of all patients were highly adherent to statin. On the other hand, CAD patients with atrial fibrillation were prescribed less antiplatelet therapy (p = 0.005). Those patients with valvular heart disease were prescribed less antiplatelet and statin (p< 0.05, p = 0.025) respectively, while patients with dyslipidemia were prescribed more statin (p< 0.001) and less β blockers(p = 0.041), patients with heart failure were prescribed less β-blockers (p = 0.023), patients with hypertension were prescribed more ACE-I or ARBs (p< 0.001). Concerning the Type of CAD, it was also correlated to the prescription of statin and β-blockers. Non pharmacological interventions played a role, patients who performed CABG were prescribed more β-blockers (p = 0.004), and more statin (p< 0.001), and patients who performed PCI were prescribed more statin significantly.

Conclusion:Adherence to guidelines and patient adherence to medications play the major factors in applying the secondary prevention strategies among the CAD patients. There is a variation in prescribing pattern of antiplatelet, statins, β-blockers, and ACE-inhibitors / ARBs. Adherence to aspirin prescribing was the highest followed by statins and β-blockers. On the other hand the adherence to prescribe ACE-inhibitors / ARBs to CAD patients was the least.