Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India

Vasc Health Risk Manag. 2009;5:1007-14. doi: 10.2147/vhrm.s8017. Epub 2009 Nov 23.

Abstract

Objective: To determine the frequency of use of pharmacotherapy with aspirin, beta blocker, statin, and angiotensin-converting enzyme (ACE) inhibitor in patients with stable coronary heart disease (CHD) among physicians at different levels of health care in Rajasthan state, India.

Methods: Physicians practicing at tertiary hospitals and clinics at tertiary, secondary and primary levels were contacted. Prescriptions of CHD patients were audited and descriptive statistics reported.

Results: We evaluated 2,993 prescriptions (tertiary hospital discharge 711, tertiary 688, secondary 1,306, and primary 288). Use of aspirin was in 2,713 (91%) of prescriptions, beta blockers 2,057 (69%), ACE inhibitors or angiotensin receptor blockers (ARBs) 2,471 (82%), and statins 2,059 (69%). Any one of these drugs was prescribed in 2,991 (100%), any two in 2,880 (96%), any three in 1,740 (58%), and all four in 1,062 (35.5%) (P < 0.001). As compared to tertiary hospital, prescriptions at tertiary, secondary, and primary levels were lower: aspirin (96% vs 95%, 91%, 67%), beta blockers (80% vs 62%, 66%, 70%), statins (87% vs 82%, 62%, 21%): two drugs (98% vs 96%, 98%, 85%), three drugs (75% vs 58%, 55%, 28%), or four drugs (54% vs 44%, 28%, 7%) (P < 0.01). Use of ACE inhibitors/ARBs was similar while nitrates (43% vs 23%, 43%, 70%), dihydropyridine calcium channel blockers (12% vs 15%, 30%, 47%), and multivitamins (6% vs 26%, 37%, 47%) use was more in secondary and primary care.

Conclusions: There is suboptimal use of various evidence-based drugs (aspirin, beta blockers, ACE inhibitors, and statins) for secondary prevention of CHD in India.

Keywords: angiotensin-converting enzyme inhibitor; aspirin; beta blockers; coronary heart disease; statins.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Aspirin / therapeutic use
  • Coronary Disease / epidemiology
  • Coronary Disease / prevention & control*
  • Coronary Disease / therapy*
  • Drug Prescriptions
  • Drug Therapy, Combination
  • Drug Utilization
  • Evidence-Based Medicine
  • Female
  • Guideline Adherence
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors*
  • India / epidemiology
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Primary Health Care* / statistics & numerical data
  • Secondary Prevention* / statistics & numerical data

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors
  • Aspirin