Adherence to prescription guidelines and achievement of treatment goals among persons with coronary heart disease in Tromsø 7

Abstract

Background: Adherence to clinical practice guidelines for coronary heart disease (CHD) reduces morbidity, mortality and treatment costs. We aimed to describe and compare adherence to prescription guidelines for persons with CHD, and explore its association with treatment goal achievement.

Method: We included all participants reporting myocardial infarction, angina, percutaneous coronary intervention and/or coronary artery bypass surgery in the seventh wave of the Tromsø Study (2015-2016, n = 1483). Medication use and treatment goal measures (blood pressure, low-density lipoprotein (LDL)-cholesterol and HbA1c) were compared to clinical practice guidelines on secondary CHD prevention. Propensity score matched logistic regression was used to assess the association between the use of antihypertensive drugs and achievement of treatment goal for blood pressure, and the use of lipid-lowering drugs (LLDs) and achievement of treatment goal for LDL-cholesterol.

Results: The prevalence of pharmacological CHD treatment was 76% for LLDs, 72% for antihypertensive drugs and 66% for acetylsalicylic acid. The blood pressure goal (< 140/90 mmHg, < 140/80 mmHg if diabetic) was achieved by 58% and the LDL-cholesterol goal (< 1.8 mmol/l or < 70 mg/dL) by 9%. There was a strong association between using LLDs and achieving the treatment goal for LDL-cholesterol (OR 14.0, 95% CI 3.6-54.7), but not between using antihypertensive drugs and blood pressure goal achievement (OR 1.4, 95% CI 0.7-2.7).

Conclusion: Treatment goal achievement of LDL-cholesterol and blood pressure was low, despite the relatively high use of LLDs and antihypertensive drugs. Further research is needed to find the proper actions to increase achievement of the treatment goals.

Keywords: Antihypertensive agents; Blood pressure; Coronary heart disease; Lipid-lowering drugs; Low-density lipoprotein (LDL)-cholesterol; Prescription guidelines.

Fig. 1

Distribution of participants across coronary heart disease groups in Tromsø 7. AP, angina pectoris; CABG, coronary artery bypass surgery; MI, myocardial infarction; PCI, percutaneous coronary intervention

Fig. 2

Proportion of participants using medications for CHD in total and across the CHD disease groups. AP, angina pectoris; ASA, acetylsalicylic acid; CABG, coronary artery bypass surgery; CHD, coronary heart disease; LLD, lipid-lowering drug; MI, myocardial infarction; PCI, percutaneous coronary intervention

Fig. 3

Proportion of participants achieving the treatment goals, in total and across the CHD disease groups. a Blood pressure, treatment goal < 140/90 mmHg (< 140/80 mmHg if diabetic). The panel also shows the proportion with blood pressure close to treatment goal. b Low-density lipoprotein (LDL)-cholesterol, treatment goal < 1.8 mmol/l (< 70 mg/dL). The panel also shows the proportion with LDL-cholesterol < 2.5 mmol/l (< 97 mg/dL, treatment goal for persons at high risk of CHD) and < 3.0 mmol/l (< 116 mg/dL, treatment goal for persons at moderate risk of CHD). c both treatment goals (y-axis 0–10%). AP, angina pectoris; CABG, coronary artery bypass surgery; CHD, coronary heart disease; MI, myocardial infarction; PCI, percutaneous coronary intervention