Abstract
Aim . We aim to evaluate the adherence to ACC/AHA guidelines for secondary prevention in a representative population of 35-79 years old living in Northern Italy, in 2007-2008. Methods . The study population comprises the 35-79 years old residents in the Varese Province. From the regional Hospital Discharge Record database we identified n=1917 hospitalizations with a main discharge code ICD-IX 410.xx occurring in the 17 surveyed hospitals. Clinical information was available for n=1908 events; according to the ACC/AHA 2008 performance measures, data collection included ASA administration at arrival, in-hospital assessment of left ventricular systolic function and LDL-cholesterol, prescription of ASA, beta-blockers and statin at discharge, as well as smoking cessation advice. Data on documented contraindications were also carefully collected. N=87 non acute events were excluded, leaving a final number of n=1821 records. The main performance measure is the proportion of patients treated according to guidelines among those without documented contraindications (eligible patients). We further considered a sex- and age at admission-adjusted analysis, by means of a logistic model. Results . Mean age at admission was 64.6±10.5 years, 72.8% were men. Data availability was above 90% for all the indicators. Almost 95% of patients received ASA at arrival; 91% had evaluation of left ventricular systolic function, and 69% had an evaluation of LDL-cholesterol during the hospitalization. ASA, beta-blockers and statin at discharge were prescribed to 94.9%; 74.3%; and 91.0% of eligible patients, respectively. Smoking cessation advice in clinical records was present in 1 smoker out of 4. Women were less likely to receive a prescription for beta-blockers, and the elderly (75-79 years old) less likely to have prescription for ASA and beta-blockers at discharge. Conclusions . Overall, a high proportion of eligible patients receives the recommended drug prescription at discharge; however, gender- and age-related disparities in secondary prevention care are present. A less than expected proportion of eligible patients had in-hospital LDL assessment, reducing the number of eligible patients for statin prescription.
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