Use of evidence-based therapy for the prevention of cardiovascular events among older people

Castelino, RL; Chen, TF; Guddattu, V; Bajorek, BV

Use of evidence-based therapy for the prevention of cardiovascular events among older people

Castelino, RL Chen, TF Guddattu, V Bajorek, BV

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Publication Type:: Journal Article
Citation:: Evaluation and the Health Professions, 2010, 33 (3), pp. 276 - 301
Issue Date:: 2010-09-02

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Field	Value	Language
dc.contributor.author	Castelino, RL	en_US
dc.contributor.author	Chen, TF	en_US
dc.contributor.author	Guddattu, V	en_US
dc.contributor.author	Bajorek, BV https://orcid.org/0000-0002-2532-7187	en_US
dc.date.issued	2010-09-02	en_US
dc.identifier.citation	Evaluation and the Health Professions, 2010, 33 (3), pp. 276 - 301	en_US
dc.identifier.issn	0163-2787	en_US
dc.identifier.uri	http://hdl.handle.net/10453/16978
dc.description.abstract	Evidence-based therapies (EBTs) for the prevention of cardiovascular disease (CVD) are reportedly underutilized in older people. The primary purpose of this study was to evaluate the use of EBTs for the prevention of CVD events in older people and secondarily whether a Home Medicines Review (HMR) service by pharmacists' predicts the use of these medicines. A retrospective cross-sectional audit of HMR reports pertaining to 608 community-dwelling older people (≥65 years) was conducted. EBTs considered for this audit included four guideline-recommended therapies for CVD: antithrombotic therapy (warfarin ± antiplatelet therapy), β-blockers, statins, and angiotensin agents (angiotensin-converting enzyme inhibitors [ACEI] ± angiotensin II receptor blockers [ARBs]). The prevalence of EBT use among the older people, mean age (SD) 75.6 (7.5) years, was: 73% for antithrombotic therapy, 75% for statins, 74% for angiotensin therapy, and 35% for β-blockers. CVD risk factors warranting treatment with these EBTs were frequently associated with use of EBTs. EBTs were least likely to be used in those with coronary interventions like coronary artery bypass grafting (CABG)/stent insertion (all EBTs except angiotensin agents) and angiotensin agents in those with a history of myocardial infarction or chronic heart failure. A pharmacist-led HMR service was significantly associated with the prescribing of all 4 EBTs. The results from this study show good adherence to evidence-based guidelines in general, although there is still room for improvement to further optimize clinical outcomes in these complex patients. The study also adds to the available literature on the effectiveness of pharmacists' collaborative contribution to the care of these high-risk patients. © The Author(s) 2010.	en_US
dc.relation.ispartof	Evaluation and the Health Professions	en_US
dc.relation.isbasedon	10.1177/0163278710374854	en_US
dc.subject.classification	Public Health	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Cardiovascular Diseases	en_US
dc.subject.mesh	Adrenergic beta-Antagonists	en_US
dc.subject.mesh	Antihypertensive Agents	en_US
dc.subject.mesh	Angiotensin II Type 1 Receptor Blockers	en_US
dc.subject.mesh	Hydroxymethylglutaryl-CoA Reductase Inhibitors	en_US
dc.subject.mesh	Angiotensin-Converting Enzyme Inhibitors	en_US
dc.subject.mesh	Prevalence	en_US
dc.subject.mesh	Confidence Intervals	en_US
dc.subject.mesh	Logistic Models	en_US
dc.subject.mesh	Odds Ratio	en_US
dc.subject.mesh	Risk Assessment	en_US
dc.subject.mesh	Retrospective Studies	en_US
dc.subject.mesh	Cross-Sectional Studies	en_US
dc.subject.mesh	Health Knowledge, Attitudes, Practice	en_US
dc.subject.mesh	Evidence-Based Medicine	en_US
dc.subject.mesh	Age Factors	en_US
dc.subject.mesh	Aging	en_US
dc.subject.mesh	Health Policy	en_US
dc.subject.mesh	Aged, 80 and over	en_US
dc.subject.mesh	Pharmacists	en_US
dc.subject.mesh	Community Health Services	en_US
dc.subject.mesh	Drug Utilization Review	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.title	Use of evidence-based therapy for the prevention of cardiovascular events among older people	en_US
dc.type	Journal Article
utslib.citation.volume	3	en_US
utslib.citation.volume	33	en_US
utslib.for	1117 Public Health and Health Services	en_US
dc.location.activity	WOS:000281322300004	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Graduate School of Health
utslib.copyright.status	closed_access
pubs.issue	3	en_US
pubs.publication-status	Published	en_US
pubs.volume	33	en_US

Abstract:

Evidence-based therapies (EBTs) for the prevention of cardiovascular disease (CVD) are reportedly underutilized in older people. The primary purpose of this study was to evaluate the use of EBTs for the prevention of CVD events in older people and secondarily whether a Home Medicines Review (HMR) service by pharmacists' predicts the use of these medicines. A retrospective cross-sectional audit of HMR reports pertaining to 608 community-dwelling older people (≥65 years) was conducted. EBTs considered for this audit included four guideline-recommended therapies for CVD: antithrombotic therapy (warfarin ± antiplatelet therapy), β-blockers, statins, and angiotensin agents (angiotensin-converting enzyme inhibitors [ACEI] ± angiotensin II receptor blockers [ARBs]). The prevalence of EBT use among the older people, mean age (SD) 75.6 (7.5) years, was: 73% for antithrombotic therapy, 75% for statins, 74% for angiotensin therapy, and 35% for β-blockers. CVD risk factors warranting treatment with these EBTs were frequently associated with use of EBTs. EBTs were least likely to be used in those with coronary interventions like coronary artery bypass grafting (CABG)/stent insertion (all EBTs except angiotensin agents) and angiotensin agents in those with a history of myocardial infarction or chronic heart failure. A pharmacist-led HMR service was significantly associated with the prescribing of all 4 EBTs. The results from this study show good adherence to evidence-based guidelines in general, although there is still room for improvement to further optimize clinical outcomes in these complex patients. The study also adds to the available literature on the effectiveness of pharmacists' collaborative contribution to the care of these high-risk patients. © The Author(s) 2010.

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http://hdl.handle.net/10453/16978