Prescription Patterns of Cardiovascular Drugs in UK Primary Care

Sarfaroj Khan 

July 24, 2020

Takeaway

  • Multiple cardiovascular drugs treatment is common in patients with cardiovascular disease (CVD) in the UK; two-fifths of the patients receive CV polypharmacy (concurrent use of 5 or more CVD drugs).

  • High-risk factors of CVD are associated with CV polypharmacy.

Why this matters

  • Findings warrant further studies to assess the impact of CV polypharmacy and its interaction on CVD recurrence and mortality.

Study design

  • This cross-sectional study included 121,600 patients (age, ≥45 years) with the first record of CHD (n=59,843) or stroke (n=61,757) between 2007 and 2016 using data from The Health Improvement Network (THIN) database.

  • Patterns of CV drugs prescribed during the first 90 days after the first CV events were assessed.

  • Funding: None disclosed.

Key results

  • The proportion of patients with CVD who were prescribed 0-1, 2-3, 4-5 and ≥6 drugs was 11.0%, 29.8%, 38.6% and 20.5%, respectively.

  • Overall, 40.6% of patients with CVD received CV polypharmacy; the average number of CV drugs was 3.9 in patients with CVD (CHD: 4.8; stroke: 3.1)

  • Factors associated with CV polypharmacy included (OR; 95% CI):

    • sex (women: 0.74 [0.72-0.76] vs men);

    • age (>85 years old: 0.50 [0.47-0.53] vs 45-54 years old);

    • smoking status (current smoking: 1.19 [1.15-1.24] vs never);

    • body mass index (obesity: 1.38 [1.34-1.43] and overweight: 1.23 [1.19-1.27] vs normal weight);

    • hypertension (stage 1: 1.06 [1.03-1.09]; stage 2: 1.08 [1.04-1.13]; and stage 3: 1.24 [1.17-1.32] vs normal blood pressure)

    • deprivation status (most deprived: 1.06 [1.04-1.14] vs least deprived);

    • history of percutaneous coronary intervention (5.26 [4.96-5.58] vs no history); and

    • Charlson comorbidity index (index ≥5: 1.25 [1.16-1.35] vs index 0).

  • CVD patients with hypertension, hyperlipidaemia, heart failure, diabetes, chronic kidney disease and arrhythmia were more likely to be prescribed ≥5 CV drugs.

  • History of dementia, chronic obstructive pulmonary disease or asthma reduced the probability of CV polypharmacy.

Limitations

  • Dataset only provides records of prescriptions.

  • THIN database does not capture data from hospital treatment and over-the-counter drugs.

Ma TT, Wong ICK, Whittlesea C, Mackenzie IS, Man KKC, Lau W, Brauer R, Wei L. Initial cardiovascular treatment patterns during the first 90 days following an incident cardiovascular event. Br J Clin Pharmacol. 2020 Jul 9 [Epub ahead of print]. doi: 10.1111/bcp.14463. PMID: 32643191 View abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.

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