We are upgrading the repository! A content freeze is in effect until December 6, 2024. New submissions or changes to existing items will not be allowed during this period. All content already published will remain publicly available for searching and downloading. Updates will be posted in the Website Upgrade 2024 FAQ in the sidebar Help menu. Reach out to escholarship@umassmed.edu with any questions.
Disparities in combination drug therapy use in older adults with coronary heart disease: a cross-sectional time-series in a nationally representative US sample
UMass Chan Affiliations
Department of Medicine, Division of Geriatric MedicineMeyers Primary Care Institute
Department of Medicine, Division of Cardiovascular Medicine
Document Type
Journal ArticlePublication Date
2010-01-29Keywords
Adrenergic beta-AntagonistsAdult
Aged
Angiotensin-Converting Enzyme Inhibitors
Antihypertensive Agents
Cardiovascular Agents
Cardiovascular Diseases
Coronary Disease
Drug Prescriptions
Drug Therapy, Combination
Ethnic Groups
Humans
*Medicare
*Physician's Practice Patterns
Sex Factors
United States
Bioinformatics
Biostatistics
Epidemiology
Health Services Research
Metadata
Show full item recordAbstract
BACKGROUND: Despite evidence of effective combination drug therapy for secondary prevention of coronary heart disease (CHD), older adults with this condition remain undertreated. OBJECTIVE: To describe time trends (1992-2003) in the adoption of combination cardiac drug therapies (beta-blockers [beta-adrenoceptor antagonists], ACE inhibitors or angiotensin II type 1 receptor antagonists [angiotensin receptor blockers; ARBs], and lipid-lowering agents) among older adults in the US with CHD and to identify factors associated with not using combination therapy. METHODS: The study took the form of a cross-sectional time-series. The study population consisted of a nationally representative sample of adults aged >or=65 years with CHD (unweighted n = 6331; weighted n = 20.1 million) included in the 1992-2003 Medicare Current Beneficiary Survey. The outcome measure was low-intensity cardiac pharmacotherapy (no drug or single drug therapy with beta-blockers, ACE inhibitors/ARBs or lipid-lowering agents) compared with combination therapy (>or=2 cardiac drugs) for secondary CHD prevention. RESULTS: The use of combination drug therapy in older adults with CHD increased 9-fold during the study period (from 6% in 1992 to 54% in 2003). Adjusted analyses demonstrate that suboptimal drug therapy was independently associated with advanced age (relative risk [RR] 1.18; 95% CI 1.14, 1.23) for patients aged >or=85 years versus patients aged 65-74 years, and with being non-Hispanic Black (RR 1.05; 95% CI 1.01, 1.10) or Hispanic (RR 1.13; 95% CI 1.06, 1.21) versus being non-Hispanic White. CONCLUSIONS: Combination drug therapy use for secondary CHD prevention increased in older US adults over the last decade, but improvements were not uniform. The oldest-old, non-Hispanic Blacks and Hispanics experienced slower adoption of optimal medical therapy to improve their long-term prognosis for CHD.Source
Drugs Aging. 2010;27(2):149-58. doi: 10.2165/11532150-000000000-00000. Link to article on publisher's siteDOI
10.2165/11532150-000000000-00000Permanent Link to this Item
http://hdl.handle.net/20.500.14038/47221PubMed ID
20104940Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.2165/11532150-000000000-00000