An estimated 580,000 Australian adults have coronary heart disease (CHD). CHD is the leading single cause of disease burden and death in Australia and has substantial costs for both the individual and the health system.
Acute coronary syndrome (ACS) is a subset of CHD, which includes heart attacks and unstable angina, which are sudden, severe and life‑threatening events. CHD is the most common form of cardiovascular disease (CVD).
People who have been hospitalised for CHD are at higher risk of having another cardiovascular event in the future. However, they can take steps to reduce this risk, including by taking cardiovascular medicines. Australian Clinical Guidelines Management of Acute Coronary Syndromes recommend that people who survive a CHD event be prescribed a multi-drug regime. Despite evidence that this substantially reduces the risk of future cardiovascular events, research indicates that not all patients are being prescribed and/or are taking these medicines.
This project explores some of the factors that affect medication use by CHD patients discharged from hospital. It found that younger patients and women were among those people less likely to be dispensed cardiovascular medicines and/or to still be taking them 1 year after leaving hospital. This information may help policy-makers and health practitioners to develop strategies to improve medication use among these groups.
The project uses the National Integrated Health Services Information Analysis Asset
(NIHSI AA), which links data from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, hospitals, residential aged care and the National Death Index. Use of this linked data set allows a better understanding of how people use and interact with the health system.
The NIHSI AA includes data from New South Wales, Victoria, Queensland, South Australia, Tasmania and the Australian Capital Territory.
The project analysed data for 67,800 people who had been admitted to hospital with CHD between 1 July 2016 and 30 June 2017. About half (35,200, or 52%) of these people had acute coronary syndrome (ACS), which covers heart attacks and unstable angina.
The analysis found that:
- 3 in 5 (61%) people with ACS were dispensed 3 or more of the recommended cardiovascular medicines within 40 days of leaving hospital. Women, and people aged under 65 with less severe CHD subtypes, were less likely to be dispensed the recommended medicines within this time frame
- around 3 in 4 (74%) of all CHD patients were still taking their medicines 1 year after leaving hospital. People in older age groups and those who regularly saw their general practitioner (GP) were more likely to be doing so
- people who had been dispensed the medicines in the year before going to hospital were significantly more likely to be dispensed medicines after being discharged from hospital and to be still taking them 1 year later
- 1 in 5 (21%) CHD patients had an emergency CVD-related readmission and 1 in 15 (6.6%) died within 2 years after the hospital admission.
Further work is required to identify why some population subgroups were less likely to initiate, or continue to access, preventive medications after hospitalisation for ACS.
2. About the project
- Reference period
- Cohort selection
- What were the cohort characteristics?
- How did the cohort’s comorbidity profiles differ?
- Were CVD medications used prior to the index hospitalisation?
- Did the cohort use community-based health services prior to the index hospitalisation?
- What were the major health outcomes?
- Did the cohort use community-based health services after the index hospitalisation?
- How did people use guideline-indicated CVD medications following the index hospitalisation?
- What are the factors associated with initiation?
- What are the factors associated with persistence?
- What are the factors associated with adherence?
- Use of CVD medicines
- Community health care and medication use
End matter: Acknowledgements; Abbreviations; Glossary; References.