Tohoku J. Exp. Med., 2020 October, 252(2)

Guideline-Based Medications for Older Adults Discharged after Percutaneous Coronary Intervention in a Suburban City of Japan: A Cohort Study Using Claims Data

KOKI SHIMADA,1 SHOTA HAMADA,2,3 MITSUAKI SAWANO,4 HIROYUKI YAMAMOTO,1 SATORU YOSHIE,1,2,5,6,7 KATSUYA IIJIMA6,7 and HIROAKI MIYATA1

1Department of Health Policy and Management, School of Medicine, Keio University, Tokyo, Japan
2Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, Tokyo, Japan
3Department of Health Services Research, University of Tsukuba, Tsukuba, Ibaraki, Japan
4Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
5Health Services Research and Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan
6Institute of Gerontology, The University of Tokyo, Tokyo, Japan
7Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan

Secondary prevention with medications is essential for the better prognosis of patients who have experienced cardiovascular events. We aimed to evaluate the use of guideline-based medications for secondary prevention in older adults in the community settings after discharge following percutaneous coronary intervention (PCI). A retrospective cohort study was conducted using anonymized claims data of older beneficiaries in a suburban city of Japan between April 2012 and March 2015. The prescriptions of antiplatelets, statins, angiotensin-converting enzyme inhibitors (ACEi)/angiotensin II receptor blockers (ARB), and β-blockers were evaluated for 3 months before and after the month in which the participants underwent PCI. Multivariable logistic regression analysis was conducted to evaluate the associations of age (“pre-old” group [63-72 years] vs. “old” group [ge; 73 years]) and sex with the prescriptions, adjusting for whether a participant was followed-up by the PCI-performing hospital. Of 815 participants, 59.6% constituted the old group and 70.9% were men. The prescription rates for antiplatelets, statins, ACEi/ARB, and β-blockers after discharge were 94.6%, 65.0%, 59.3%, and 32.9%, respectively. The adjusted analysis indicated that statins were less likely to be prescribed for the old group (adjusted odds ratio [aOR], 0.70; 95% confidence interval [CI], 0.51-0.95; p = 0.023) and for men (aOR, 0.64; 95% CI, 0.45-0.89; p = 0.008). β-blockers were more likely to be prescribed for men (aOR, 1.66; 95% CI, 1.17-2.33; p = 0.004). Our results suggest the potential for improvements in secondary prevention by increasing the prescription rates of guideline-based medications in this population.

Keywords —— claims data; coronary artery disease; elderly; percutaneous coronary intervention; secondary prevention

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Tohoku J. Exp. Med., 2020 , 252, 143-152.

Correspondence: Shota Hamada, Research Department, Institute for Health Economics and Policy, Association for Health Economics Research and Social Insurance and Welfare, No.11 Toyo-Kaiji Bldg, 1-5-11 Nishi-Shimbashi, Minato-ku, Tokyo 105-0003, Japan.

e-mail: shota.hamada@ihep.jp