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Optimal Medical Therapy Prescribing Patterns and Disparities Identified in Patients with Acute Coronary Syndromes at an Academic Medical Center in an Area with High Coronary Heart Disease-Related Mortality

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Abstract

Background

Coronary heart disease (CHD)-related mortality is high in the southern United States. A five-drug pharmacotherapy regimen for acute coronary syndromes (ACS), defined as optimal medical therapy (OMT), can decrease CHD-related mortality. Studies have indicated that OMT is prescribed 50–60% of the time. Assessment of prescribing could provide insight into the potential etiology of disparate mortality.

Objective

The aim was to evaluate prescribing of OMT at discharge in patients presenting with an ACS event at an academic medical center and identify patients at risk of not receiving OMT.

Methods

A single-center, retrospective cohort of patients with ACS diagnosis between July 2013 and July 2015 was investigated, and a multivariable regression analysis conducted to identify populations at risk of not receiving OMT.

Results

A total of 864 patients were identified by International Classification of Diseases, Ninth Revision (ICD-9) codes, with 533 excluded and 331 analyzed. OMT was prescribed in 69.79%. Patients ≥ 75 years of age [p = 0.003; odds ratio (OR) 0.30; 95% confidence interval (CI) 0.136–0.673], unstable angina presentation (p = 0.042; OR 0.55; 95% CI 0.307–0.977), and surgical management (p = 0.001; OR 0.22; 95% CI 0.095–0.519) were less likely to receive OMT.

Conclusions

The percentage of patients prescribed OMT exceeded the reported global percentage of prescribed OMT. However, disparities exist among specific populations.

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Acknowledgements

We would like to acknowledge Chelsea LaPreze, Pharm.D., for her contributions to data collection for this project.

Author information

Authors and Affiliations

  1. Department of Pharmacy: Clinical and Administrative Sciences, The University of Oklahoma College of Pharmacy, 1122 N.E. 13th Street, Suite 4409, Oklahoma City, OK, 73117, USA

    Ashley N. Fox

  2. Department of Pharmacy: Clinical and Administrative Sciences, The University of Oklahoma College of Pharmacy, 1110 N. Stonewall Ave, #214, Oklahoma City, OK, 73117, USA

    Grant H. Skrepnek

  3. Department of Pharmacy: Clinical and Administrative Sciences, The University of Oklahoma College of Pharmacy, 1122 N.E. 13th Street, #4417, Oklahoma City, OK, 73117, USA

    Jamie L. Miller

  4. Department of Pharmacy: Clinical and Administrative Sciences, The University of Oklahoma College of Pharmacy, 1110 N. Stonewall Ave, #217, Oklahoma City, OK, 73117, USA

    Nicholas C. Schwier

  5. TRC Healthcare, Pharmacist’s Letter, Oklahoma City, OK, USA

    Toni L. Ripley

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  1. Ashley N. Fox
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  2. Grant H. Skrepnek
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  3. Jamie L. Miller
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Corresponding author

Correspondence to Ashley N. Fox.

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Conflict of interest

Authors Fox, Miller, Skrepnek, Schwier, and Ripley declare they have no potential conflicts of interest that might be relevant to the contents of this manuscript.

Funding

No external funding was used in the preparation of this manuscript. None of the authors received grant support or other types of extramural funding for the writing of this manuscript.

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Fox, A.N., Skrepnek, G.H., Miller, J.L. et al. Optimal Medical Therapy Prescribing Patterns and Disparities Identified in Patients with Acute Coronary Syndromes at an Academic Medical Center in an Area with High Coronary Heart Disease-Related Mortality. Am J Cardiovasc Drugs 19, 185–193 (2019). https://doi.org/10.1007/s40256-018-0308-x

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  • DOI: https://doi.org/10.1007/s40256-018-0308-x

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