Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction

Abstract

Background: In an accompanying article, we report moderate between-hospital variation in the postdischarge of β-blockers, angiotensin-modifying drugs and statins elderly patients who had been admitted to hospital with acute myocardial infarction. Our objective was to identify the characteristics of patients, physicians, hospitals communities associated with differences in the use these medications after discharge. Methods: For this retrospective, population-based cohort study, we used linked administrative databases. We examined data for all patients aged 65 years or older who were discharged from hospital in 2005/06 with a diagnosis myocardial infarction. We determined the effect of patient, physician, hospital and community characteristics the rate of postdischarge medication use. Results: Increasing patient age was associated with lower postdischarge use of medications. The odds ratios (ORs) a 1-year increase in age were 0.98 (95% confidence interval [CI] 0.97-0.99) for β-blockers, 0.97 (95% CI 0.97-0.98) for angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers and 0.94 (95% CI 0.93-0.95) for statins. Having a general or family practitioner, a general internist or a physician of another specialty as the attending physician, relative to having a cardiologist, was associated with lower postdischarge use of β-blockers, angiotensin-modifying agents and statins (ORs ranging from 0.46 to 0.82). Having an attending physician with or more years experience, relative to having a physician who had graduated within the past 15 years, was associated with lower use of β-blockers (OR 0.71, 95% 0.60-0.84) and statins (OR 0.81, 95% CI 0.67-0.97). Interpretation: Patients who received care from noncardiologists and physicians with at least 29 years of experience had substantially lower use of evidence-based drug therapies after discharge. Dissemination strategies should devised to improve the prescribing of evidence-based medications by these physicians. © 2008 Canadian Medical Association or its licensors.