Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care

David Williams, Kenneth Arthur Bennett, J. Feely

Research output: Contribution to journalArticle

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Abstract

Aims To determine if a gender or age bias exists in the prescription of important secondary preventive therapies for ischaemic heart disease in primary care.

Methods We identified 15 590 patients with ischaemic heart disease on the basis that they received a prescription for nitrate therapy over a 1-year period (September 1999 to August 2000) from the Eastern Region of the General Medical Services scheme in Ireland (population of 334 031), which provides free health service to those eligible patients in primary care. Odds ratios (OR) for the prescription of aspirin, beta-blockers, statins, calcium channel antagonists and ACE inhibitors in women and in those aged >65 years were determined.

Results Female patients were less likely to receive a prescription for a beta-blocker [OR = 0.84, 95% confidence interval (CI) = 0.79, 0.89, P < 0.001], aspirin (OR = 0.72, 95% CI = 0.67, 0.78, P < 0.001), and ACE inhibitors (OR = 0.83, 95% CI = 0.78, 0.89, P < 0.001) compared with their male counterparts. However, women were more likely to receive anxiolytic benzodiazepines (OR = 1.71, 95% CI = 1.59, 1.85, P < 0.001) compared with their male counterparts. Elderly patients (aged >65 years) were less likely to receive aspirin (OR = 0.92, 95% CI = 0.85, 0.99, P < 0.001), &beta;-blocker (OR = 0.66, 95% CI = 0.62, 0.71, P < 0.001) and a statin (OR = 0.5, 95% CI = 0.46, 0.53, P < 0.001).

Conclusions An age and gender bias exists in the prescription of important secondary preventive therapies in primary care that may lead to increased mortality from ischaemic heart disease in these groups.

Original languageEnglish
Pages (from-to)604-610
Number of pages6
JournalBritish Journal of Clinical Pharmacology
Volume55
DOIs
Publication statusPublished - 2003

Keywords

  • gender
  • ischaemic heart disease
  • nitrates
  • ACUTE MYOCARDIAL-INFARCTION
  • CORONARY-ARTERY DISEASE
  • BYPASS SURGERY
  • RISK-FACTORS
  • WOMEN
  • SIMVASTATIN
  • GUIDELINES
  • POPULATION
  • ANXIETY
  • THERAPY

Cite this

Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care. / Williams, David; Bennett, Kenneth Arthur; Feely, J.

In: British Journal of Clinical Pharmacology, Vol. 55, 2003, p. 604-610.

Research output: Contribution to journalArticle

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title = "Evidence for an age and gender bias in the secondary prevention of ischaemic heart disease in primary care",
abstract = "Aims To determine if a gender or age bias exists in the prescription of important secondary preventive therapies for ischaemic heart disease in primary care.Methods We identified 15 590 patients with ischaemic heart disease on the basis that they received a prescription for nitrate therapy over a 1-year period (September 1999 to August 2000) from the Eastern Region of the General Medical Services scheme in Ireland (population of 334 031), which provides free health service to those eligible patients in primary care. Odds ratios (OR) for the prescription of aspirin, beta-blockers, statins, calcium channel antagonists and ACE inhibitors in women and in those aged >65 years were determined.Results Female patients were less likely to receive a prescription for a beta-blocker [OR = 0.84, 95{\%} confidence interval (CI) = 0.79, 0.89, P < 0.001], aspirin (OR = 0.72, 95{\%} CI = 0.67, 0.78, P < 0.001), and ACE inhibitors (OR = 0.83, 95{\%} CI = 0.78, 0.89, P < 0.001) compared with their male counterparts. However, women were more likely to receive anxiolytic benzodiazepines (OR = 1.71, 95{\%} CI = 1.59, 1.85, P < 0.001) compared with their male counterparts. Elderly patients (aged >65 years) were less likely to receive aspirin (OR = 0.92, 95{\%} CI = 0.85, 0.99, P < 0.001), &beta;-blocker (OR = 0.66, 95{\%} CI = 0.62, 0.71, P < 0.001) and a statin (OR = 0.5, 95{\%} CI = 0.46, 0.53, P < 0.001).Conclusions An age and gender bias exists in the prescription of important secondary preventive therapies in primary care that may lead to increased mortality from ischaemic heart disease in these groups.",
keywords = "gender, ischaemic heart disease, nitrates, ACUTE MYOCARDIAL-INFARCTION, CORONARY-ARTERY DISEASE, BYPASS SURGERY, RISK-FACTORS, WOMEN, SIMVASTATIN, GUIDELINES, POPULATION, ANXIETY, THERAPY",
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AU - Williams, David

AU - Bennett, Kenneth Arthur

AU - Feely, J.

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N2 - Aims To determine if a gender or age bias exists in the prescription of important secondary preventive therapies for ischaemic heart disease in primary care.Methods We identified 15 590 patients with ischaemic heart disease on the basis that they received a prescription for nitrate therapy over a 1-year period (September 1999 to August 2000) from the Eastern Region of the General Medical Services scheme in Ireland (population of 334 031), which provides free health service to those eligible patients in primary care. Odds ratios (OR) for the prescription of aspirin, beta-blockers, statins, calcium channel antagonists and ACE inhibitors in women and in those aged >65 years were determined.Results Female patients were less likely to receive a prescription for a beta-blocker [OR = 0.84, 95% confidence interval (CI) = 0.79, 0.89, P < 0.001], aspirin (OR = 0.72, 95% CI = 0.67, 0.78, P < 0.001), and ACE inhibitors (OR = 0.83, 95% CI = 0.78, 0.89, P < 0.001) compared with their male counterparts. However, women were more likely to receive anxiolytic benzodiazepines (OR = 1.71, 95% CI = 1.59, 1.85, P < 0.001) compared with their male counterparts. Elderly patients (aged >65 years) were less likely to receive aspirin (OR = 0.92, 95% CI = 0.85, 0.99, P < 0.001), &beta;-blocker (OR = 0.66, 95% CI = 0.62, 0.71, P < 0.001) and a statin (OR = 0.5, 95% CI = 0.46, 0.53, P < 0.001).Conclusions An age and gender bias exists in the prescription of important secondary preventive therapies in primary care that may lead to increased mortality from ischaemic heart disease in these groups.

AB - Aims To determine if a gender or age bias exists in the prescription of important secondary preventive therapies for ischaemic heart disease in primary care.Methods We identified 15 590 patients with ischaemic heart disease on the basis that they received a prescription for nitrate therapy over a 1-year period (September 1999 to August 2000) from the Eastern Region of the General Medical Services scheme in Ireland (population of 334 031), which provides free health service to those eligible patients in primary care. Odds ratios (OR) for the prescription of aspirin, beta-blockers, statins, calcium channel antagonists and ACE inhibitors in women and in those aged >65 years were determined.Results Female patients were less likely to receive a prescription for a beta-blocker [OR = 0.84, 95% confidence interval (CI) = 0.79, 0.89, P < 0.001], aspirin (OR = 0.72, 95% CI = 0.67, 0.78, P < 0.001), and ACE inhibitors (OR = 0.83, 95% CI = 0.78, 0.89, P < 0.001) compared with their male counterparts. However, women were more likely to receive anxiolytic benzodiazepines (OR = 1.71, 95% CI = 1.59, 1.85, P < 0.001) compared with their male counterparts. Elderly patients (aged >65 years) were less likely to receive aspirin (OR = 0.92, 95% CI = 0.85, 0.99, P < 0.001), &beta;-blocker (OR = 0.66, 95% CI = 0.62, 0.71, P < 0.001) and a statin (OR = 0.5, 95% CI = 0.46, 0.53, P < 0.001).Conclusions An age and gender bias exists in the prescription of important secondary preventive therapies in primary care that may lead to increased mortality from ischaemic heart disease in these groups.

KW - gender

KW - ischaemic heart disease

KW - nitrates

KW - ACUTE MYOCARDIAL-INFARCTION

KW - CORONARY-ARTERY DISEASE

KW - BYPASS SURGERY

KW - RISK-FACTORS

KW - WOMEN

KW - SIMVASTATIN

KW - GUIDELINES

KW - POPULATION

KW - ANXIETY

KW - THERAPY

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DO - 10.1046/j.1365-2125.2003.01795.x

M3 - Article

VL - 55

SP - 604

EP - 610

JO - British Journal of Clinical Pharmacology

JF - British Journal of Clinical Pharmacology

SN - 0306-5251

ER -