Trends and Variations in the Prescribing of Secondary Preventative Cardiovascular Therapies for Non-ST Elevation Myocardial Infarction (NSTEMI) in Malaysia

Overview

Journal Eur J Clin Pharmacol

Specialty Pharmacology

Date 2018 Mar 28

PMID 29582106

Citations 6

Authors

Padmaa Venkatason

Nur Lisa Zaharan

Muhammad Dzafir Ismail

Wan Azman Wan Ahmad

Ahmad Syadi Mahmood Zuhdi

Affiliations

Soon will be listed here.

Abstract

Purpose: Information is lacking on prescribing of preventative cardiovascular pharmacotherapies for patients with non-ST elevation myocardial infarction (NSTEMI) in the Asian region. This study examined the prescribing rate of these pharmacotherapies, comparing NSTEMI to STEMI, and variations across demographics and clinical factors within the NSTEMI group in the multi-ethnic Malaysian population.

Methods: This is a retrospective analysis of the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry from year 2006 to 2013 (n = 30,873). On-discharge pharmacotherapies examined were aspirin, ADP-antagonists, statins, ACE-inhibitors, angiotensin-II-receptor blockers, and beta-blockers. Multivariate logistic regression was used to calculate adjusted odds ratio of receiving individual pharmacotherapies according to patients' characteristics in NSTEMI patients (n = 11,390).

Results: Prescribing rates for cardiovascular pharmacotherapies had significantly increased especially for ADP-antagonists (76%) in NSTEMI patients. More than 85% were prescribed statins and antiplatelets but rates remained significantly lower compared to STEMI. Women and those over 65 years old were less likely to be prescribed these pharmacotherapies compared to men and younger NSTEMI patients. Chinese and Indians were more likely to receive selected pharmacotherapies compared to Malays (main ethnicity). Geographical variations were observed; East Malaysian (Malaysian Borneo) patients were less likely to receive these compared to Western region of Malaysian Peninsular. Underprescribing in patients with risk factors such as diabetes were observed with other co-morbidities influencing prescribing selectively.

Conclusion: This study uncovers demographic and clinical variations in cardiovascular pharmacotherapies prescribing for NSTEMI. Concerted efforts by policy makers, specialty societies, and physicians are required focusing on elderly, women, Malays, East Malaysians, and high-risk patients.

Citing Articles

Prescribing Trends of Renin-Angiotensin System Inhibitors and Mortality among Acute Coronary Syndrome Patients: Insights from the Malaysian National Cardiovascular Disease Registry.

Suki S, Zuhdi A, Yahya A, Adnan W, Zaharan N Saudi J Med Med Sci. 2024; 12(2):145-152.

PMID: 38764563 PMC: 11098274. DOI: 10.4103/sjmms.sjmms_422_23.

Identifying and Solving Gaps in Pre- and In-Hospital Acute Myocardial Infarction Care in Asia-Pacific Countries.

Tern P, Vaswani A, Yeo K Korean Circ J. 2023; 53(9):594-605.

PMID: 37653695 PMC: 10475691. DOI: 10.4070/kcj.2023.0169.

Ethical issues with geographical variations in the provision of health care services.

Hofmann B BMC Med Ethics. 2022; 23(1):127.

PMID: 36474244 PMC: 9724375. DOI: 10.1186/s12910-022-00869-7.

Intervention and in-hospital pharmacoterapies in octogenarian with acute coronary syndrome: a 10-year retrospective analysis of the Malaysian National Cardiovascular Database (NCVD) registry.

Suki S, Zuhdi A, Yahya A, Zaharan N BMC Geriatr. 2022; 22(1):23.

PMID: 34983393 PMC: 8729007. DOI: 10.1186/s12877-021-02724-7.

Characteristics and short-term outcomes of young women with acute myocardial infarction in Malaysia: a retrospective analysis from the Malaysian National Cardiovascular Database registry.

Venkatason P, Zubairi Y, Zaharan N, Wan Ahmad W, Hafidz M, Ismail M BMJ Open. 2019; 9(11):e030159.

PMID: 31748289 PMC: 6886979. DOI: 10.1136/bmjopen-2019-030159.

References

Hull S, Mathur R, Boomla K, Chowdhury T, Dreyer G, Alazawi W . Research into practice: understanding ethnic differences in healthcare usage and outcomes in general practice. Br J Gen Pract. 2014; 64(629):653-5. PMC: 4240145. DOI: 10.3399/bjgp14X683053. View

Venkatason P, Zubairi Y, Hafidz I, Wan W, Zuhdi A . Trends in evidence-based treatment and mortality for ST elevation myocardial infarction in Malaysia from 2006 to 2013: time for real change. Ann Saudi Med. 2016; 36(3):184-9. PMC: 6074549. DOI: 10.5144/0256-4947.2016.184. View

De Luca L, Olivari Z, Bolognese L, Lucci D, Gonzini L, Di Chiara A . A decade of changes in clinical characteristics and management of elderly patients with non-ST elevation myocardial infarction admitted in Italian cardiac care units. Open Heart. 2014; 1(1):e000148. PMC: 4267110. DOI: 10.1136/openhrt-2014-000148. View

Buja A, Boemo D, Furlan P, Bertoncello C, Casale P, Baldovin T . Tackling inequalities: are secondary prevention therapies for reducing post-infarction mortality used without disparities?. Eur J Prev Cardiol. 2012; 21(2):222-30. DOI: 10.1177/2047487312462148. View

Minh H, Pocock N, Chaiyakunapruk N, Chhorvann C, Duc H, Hanvoravongchai P . Progress toward universal health coverage in ASEAN. Glob Health Action. 2014; 7:25856. PMC: 4256544. DOI: 10.3402/gha.v7.25856. View

Wan Ahmad W, Mohd Ali R, Khanom M, Han C, Bang L, Yip A . The journey of Malaysian NCVD-PCI (National Cardiovascular Disease Database-Percutaneous Coronary Intervention) Registry: a summary of three years report. Int J Cardiol. 2011; 165(1):161-4. DOI: 10.1016/j.ijcard.2011.08.015. View

Zuhdi A, Wan Ahmad W, Ahmad Zaki R, Mariapun J, Mohd Ali R, Md Sari N . Acute coronary syndrome in the elderly: the Malaysian National Cardiovascular Disease Database-Acute Coronary Syndrome registry. Singapore Med J. 2016; 57(4):191-7. PMC: 4853486. DOI: 10.11622/smedj.2015145. View

Motivala A, Cannon C, Srinivas V, Dai D, Hernandez A, Peterson E . Changes in myocardial infarction guideline adherence as a function of patient risk: an end to paradoxical care?. J Am Coll Cardiol. 2011; 58(17):1760-5. DOI: 10.1016/j.jacc.2011.06.050. View

Leigh J, Alvarez M, Rodriguez C . Ethnic Minorities and Coronary Heart Disease: an Update and Future Directions. Curr Atheroscler Rep. 2016; 18(2):9. PMC: 4828242. DOI: 10.1007/s11883-016-0559-4. View

10.

Balzi D, Bari M, Barchielli A, Ballo P, Carrabba N, Cordisco A . Should we improve the management of NSTEMI? Results from the population-based "acute myocardial infarction in Florence 2" (AMI-Florence 2) registry. Intern Emerg Med. 2012; 8(8):725-33. DOI: 10.1007/s11739-012-0817-6. View

11.

Mathur R, Badrick E, Boomla K, Bremner S, Hull S, Robson J . Prescribing in general practice for people with coronary heart disease; equity by age, sex, ethnic group and deprivation. Ethn Health. 2011; 16(2):107-23. DOI: 10.1080/13557858.2010.540312. View

12.

Tanguturi V, Temin E, Yeh R, Thompson R, Rao S, Mallick A . Clinical Interventions to Reduce Preventable Hospital Readmission After Percutaneous Coronary Intervention. Circ Cardiovasc Qual Outcomes. 2016; 9(5):600-4. DOI: 10.1161/CIRCOUTCOMES.116.003086. View

13.

Cho S, Lau S, Tandon V, Kumi K, Pfuma E, Abernethy D . Geriatric drug evaluation: where are we now and where should we be in the future?. Arch Intern Med. 2011; 171(10):937-40. DOI: 10.1001/archinternmed.2011.152. View

14.

Lu H, Nordin R, Wan Ahmad W, Lee C, Zambahari R, Ismail O . Sex differences in acute coronary syndrome in a multiethnic asian population: results of the malaysian national cardiovascular disease database-acute coronary syndrome (NCVD-ACS) registry. Glob Heart. 2015; 9(4):381-90. DOI: 10.1016/j.gheart.2014.06.001. View

15.

Mosca L, Linfante A, Benjamin E, Berra K, Hayes S, Walsh B . National study of physician awareness and adherence to cardiovascular disease prevention guidelines. Circulation. 2005; 111(4):499-510. DOI: 10.1161/01.CIR.0000154568.43333.82. View

16.

Roffi M, Patrono C, Collet J, Mueller C, Valgimigli M, Andreotti F . 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment.... Eur Heart J. 2015; 37(3):267-315. DOI: 10.1093/eurheartj/ehv320. View

17.

Sonel A, Good C, Mulgund J, Roe M, Gibler W, Smith Jr S . Racial variations in treatment and outcomes of black and white patients with high-risk non-ST-elevation acute coronary syndromes: insights from CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early.... Circulation. 2005; 111(10):1225-32. DOI: 10.1161/01.CIR.0000157732.03358.64. View

18.

Steg P, James S, Atar D, Badano L, Blomstrom-Lundqvist C, Borger M . ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33(20):2569-619. DOI: 10.1093/eurheartj/ehs215. View

19.

Gama H, Torre C, Guerreiro J, Azevedo A, Costa S, Lunet N . Use of generic and essential medicines for prevention and treatment of cardiovascular diseases in Portugal. BMC Health Serv Res. 2017; 17(1):449. PMC: 5492988. DOI: 10.1186/s12913-017-2401-2. View

20.

Puymirat E, Schiele F, Steg P, Blanchard D, Isorni M, Silvain J . Determinants of improved one-year survival in non-ST-segment elevation myocardial infarction patients: insights from the French FAST-MI program over 15 years. Int J Cardiol. 2014; 177(1):281-6. DOI: 10.1016/j.ijcard.2014.09.023. View