L SUKKAR1,2, A CAMPAIN1, C HOCKHAM1, A KANG1, T YOUNG1, M JUN1, K ROGERS1, C POLLOCK3, S ZOUNGAS1,4, C FOOTE1,5, D PEIRIS1, M JARDINE1
1The George Institute For Global Health, Sydney, Australia, 2Faculty of Medicine and Health, The University of Sydney, Sydney, Australia, 3Kolling Institute for Medical Research, Sydney, Australia, 4School of Public Health and Preventative Medicine Monash University, Melbourne, Australia, 5Concord Repatriation General Hospital, Sydney, Australia
Aim: To determine the treatment gap in the use of cardioprotective medications in Acute Myocardial Infarction (AMI) survivors, including those with high cardiovascular risk co-morbidities.
Background: Improving adherence to proven cardioprotective medications following an AMI is the shortest path to improving cardiovascular outcomes.
Methods: We identified people surviving a hospitalised ICD-10AM coded AMI (2006-2014) characterised according to CKD (eGFR<60mL/min/1.73m2) and diabetes status in the 45 and Up Study linked to hospital and community pathology datasets by the Centre for Health Record and Linkage. Adherence, defined as 80% of days covered by a dispensed prescription for both lipid-lowering and RAS blockade, was assessed from hospital discharge until study end using the Pharmaceutical Benefits Schedule provided by Services Australia.
Results: 11,470 individuals were admitted and survived a first AMI with a mean follow-up of 3.0 years (SD 2.54). Over 12 months the proportion of adherers was highest among those with both CKD and diabetes (48.8% [95%CI 44.8-52.9], followed by diabetes alone (42.3% [95%CI 39.4-45.2]), CKD alone (31.9% [95%CI 29.6-34.2]), and neither co-morbidity (23.3% [95%CI 22.2-24.5]). The utilisation of cardioprotective medications increased by 8.5% to 14% across the groups in the first 3 months following the AMI compared with pre-AMI use, and then changed little thereafter.
Conclusion: Although adherence was low overall, people with CKD or diabetes were more likely to receive guideline-indicated cardio-protection after an AMI than those with neither co-morbidity. Utilisation of cardioprotective medications increased slightly following an AMI although most was associated with prior use. Adherence did not decay over time, suggesting more effective interventions at the time of the AMI may represent a significant and cost-effective opportunity for improving cardiovascular outcomes.
Dr Louisa Sukkar is a PhD scholar at the George Institute for Global health and a clinical nephrologist. Her research interest is in understanding the progression of chronic kidney disease, its associated co-morbidities and its impact on patients. Her research explores the determinants of progression with a particular focus on processes of care of chronic disease and its relationship to health outcomes and health resource utilization