Frequency of antiplatelet therapy in coronary artery disease. Data from the disease management programme CAD

Abstract

Abstract Background Physicians always aim to improve their patients' health and consequently also improve community health. Continued medical education (CME) should be designed to support this goal and thus not only provide knowledge transfer, but also influence clinical decision-making and close performance gaps. However, the relative weight of CME in this process needs to be determined. Purpose Main purpose of the study was to analyse APT prescription rates and differences between subgroups of patients in a disease management programme (DMP) for coronary artery disease (CAD). Methods In a retrospective study we analysed prescription rates for APT in 254,932 CAD patients (male: 64.4%), treated in a total of 3,405 practices in 2019 in a DMP in the region of North Rhine, Germany, to delineate the potential for change by CME to further improve community health. Analyses were run for the whole study population stratified by sex as well as for subgroups of patients suffering from myocardial infarction / acute coronary syndrome (MI/ACS), or who have been treated with percutaneous coronary intervention (PCI) or bypass surgery. Subgroup differences were analysed in a logistic regression model. Results Patients mean age was 72.7±11.2 years (mean ± 1SD), mean duration of DMP participation was 7.2±4.7 years and mean cumulative number of DMP visits was 27±17. APT prescription rates were 85.0% in male and 78.8% in female CAD patients. In subgroups of male CAD patients APT prescription rates were between 89.7% and 92.8%, in the same subgroups of female CAD patients the corresponding rates were between 87.8% and 92.0%. Rates for a missing APT prescription per practice were between 0.0044% and 0.0062% for male and female CAD patients respectively. Rates for a missing APT prescription per practice and DMP visit were 0.0002% for both sexes. In a multivariate model significant positive predictors of APT prescription were male sex (OR=1.37, 95% CI: 1.34–1.40), age ≥76 yrs (OR=1.11, 95% CI: 1.08–1.14), participation in DMP ≥4 and <10 yrs (OR=1.19, 95% CI: 1.16–1.22), MI/ACS (OR=1.14, 95% CI: 1.08–1.20), PCI (OR=1.97, 95% CI: 1.88–2.06) and bypass surgery (OR=1.14, 95% CI: 1.08–1.21). Conclusion Our study demonstrates that a multifaceted intervention, like a DMP, can achieve high attainment rates for APT in CAD. To describe the benchmark for CME to further improve attainment rates, consideration of absolute numbers of eligible patients per practice or physician is probably more appropriate than expression of performance as percentage values. This is especially true if attainment rates show substantial variations between subgroups, if subgroups show substantial variation in size, if attainment rates are already in the order of magnitude of 80% or higher, and if there are disparities in the evidence base underlying treatment recommendations related to subgroups. Funding Acknowledgement Type of funding sources: None.