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01.12.2018 | Research article | Ausgabe 1/2018 Open Access

BMC Public Health 1/2018

The impact of age on the implementation of evidence-based medications in patients with coronary artery disease and its prognostic significance: a retrospective cohort study

Zeitschrift:
BMC Public Health > Ausgabe 1/2018
Autoren:
Tian-li Xia, Fang-yang Huang, Yi-ming Li, Hua Chai, Bao-tao Huang, Yuan-Wei-Xiang Ou, Qiao Li, Xiao-bo Pu, Zhi-liang Zuo, Yong Peng, Mao Chen, De-jia Huang
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1186/​s12889-018-5049-x) contains supplementary material, which is available to authorized users.

Abstract

Background

Elderly patients with coronary artery disease (CAD) frequently complicated with more cardiovascular risk factors, but received fewer evidence-based medications (EBMs). This study explored the association of EBMs compliance in different age groups and the risk of long-term death.

Methods

A retrospective analysis was conducted from a single registered database. 2830 consecutive patients with CAD were enrolled and grouped into 3 categories by age. The primary end point was all-cause mortality and secondary endpoint is cardiovascular mortality.

Results

The mean follow-up time was 30.25 ± 11.89 months and death occurred in 270 cases,including 150 cases of cardiac death. Cumulative survival curves indicated that the incidence rates of all-cause death and cardiovascular death increased with age (older than 75 years old vs. 60 to 75 years old vs. younger than 60 years old, mortality: 18.7% vs. 9.6% vs. 4.1%, p < 0.001; cardiovascular mortality: 10.3% vs. 5.1% vs. 2.7%, p < 0.001). The percentage of elderly patients using no EBMs was significantly higher than the percentages in the other age group (7.7% vs. 4.6% vs. 2.2%,p < 0.05). Cox regression analysis revealed the benefit of combination EBMs (all-cause mortality: hazard ratio [HR] 0.15, 95% CI 0.08–0.27; cardiac mortality: HR 0.08, 95% CI 0.04–0.19) for older CAD patients. Similar trends were found about different kinds of EBMs in elderly patients.

Conclusions

Elderly patients with CAD had higher risk of death but a lower degree of compliance with EBMs usage. Elderly CAD patients could receive more clinical benefits by using EBMs.
Zusatzmaterial
Additional file 1: Number of matched pairs, before-matched and c-statistic. (DOCX 16 kb)
12889_2018_5049_MOESM1_ESM.docx
Additional file 2: Discharge prescription of ACEI/ARBs for CAD patients (panel A) and CAD patients without hypertension (panel B) stratified by age. Abbreviations: CAD, coronary artery disease; ACEI, angiotensin-converting enzyme inhibitor; ARBs, angiotensin receptor blockers. (DOCX 95 kb)
12889_2018_5049_MOESM2_ESM.docx
Additional file 3: Multivariate Cox’s proportional hazards regression model each evidence-based medications. Abbreviations: CAD: coronary artery disease, CI: confidence interval, CV death: cardiovascular death, HR: hazard ratio, LDL-C: low-density lipoprotein-cholesterol, STEMI: ST-segment elevated myocardial infarction. Adjusted factor: sex, history of hypertension, history of diabetes mellitus, and history of heart failure, history of dyslipidemia, smoking status, eGFR and hepatic enzymes. (DOCX 13 kb)
12889_2018_5049_MOESM3_ESM.docx
Additional file 4: Multivariate Cox’s proportional hazards regression model on combination therapy of EBMs. Adjusted factor: sex, history of hypertension, history of diabetes mellitus, and history of heart failure, history of dyslipidemia, smoking status, eGFR and hepatic enzymes. Model 0: no medication; model 1: prescribed 1 type of EBMs; model 2, prescribed 2 types of EBMs; model 3, prescribed all 3 types of EBMs. Three types of EBMs included: statin, beta-blockers, and RAAS inhibitors (ACEIs or ARBs). Abbreviations: EBMs: evidence-based medications, CAD: coronary artery disease, CI: confidence interval, CV death: cardiovascular death, HR: hazard ratio. (DOCX 13 kb)
12889_2018_5049_MOESM4_ESM.docx
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