Critical gaps revealed in post-heart attack drug prescriptions

Pharma News: An Australian-first study highlights significant variations in medication strategies following heart attacks, despite established clinical guidelines intended to standardise patient care.

Researchers from Monash University’s Centre for Medicine Use and Safety (CMUS), part of the Monash Institute of Pharmaceutical Sciences (MIPS), analysed data from 15,339 heart attack admissions across Victorian hospitals over a five-year period.

Their findings reveal that due to differences in post-discharge prescribing decisions not all patients are receiving the recommended secondary prevention medications after discharge, which are crucial for long-term management and outcomes.

Clinical guidelines universally recommend four key groups of medications for all heart attack patients, including P2Y12 inhibitors, statins, ACE inhibitors/angiotensin receptor blockers (ARB), and beta-blockers. These medications are essential in reducing the risk of future cardiovascular events.

The study identified variations in medication approaches depending on the initial treatment method used to restore blood flow to the heart’s arteries post-heart attack. Two primary approaches, percutaneous coronary intervention (PCI) and coronary artery bypass grafts (CABG), were compared. PCI and CABG, while both effective in managing heart attacks, showed differing patterns in the dispensing of guideline-recommended medications.

Lead author Adam Livori, a consultant cardiology pharmacist from Grampians Health and CMUS PhD candidate, emphasised the disparity.

“Despite clear evidence of medication benefits in the year following a heart attack, we’re seeing notably lower dispensing rates of all four guideline-recommended medication classes following CABG procedures, with some studies reporting rates as low as 32%,” Livori explained.

He further added, “Comparatively, dispensing of all four recommended medication classes was more common among people undergoing PCI. This is largely due to far fewer people who underwent CABG being dispensed P2Y12 inhibitors, which is one of the four drug classes recommended.”

While there is a relatively high uptake of cholesterol-lowering medications (statins) across all patients, the use of other essential secondary prevention medicines remains lower among CABG patients compared to PCI patients.

The study underscores the need for further research to understand the factors influencing these disparities.

“Given guideline recommendations are fairly consistent for those who undergo CABG and PCI, further research is needed to understand the drivers behind these observed differences so that implementation efforts to improve uptake of secondary prevention medications can be undertaken,” he emphasised.

“Efforts aimed at the post-discharge period may be of particular benefit with respect to improving the use of ACE inhibitors/ARB and P2Y12 inhibitors among post-CABG patients. Initiatives to promote uptake of secondary prevention medications are likely to be cost-effective and increasingly important in the context of overstretched healthcare systems,” the authors concluded.

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