L’ADERENZA ALLA TERAPIA FARMACOLOGICA EVIDENCE-BASED DOPO DIMISSIONE OSPEDALIERA A SEGUITO DI INFARTO MIOCARDICO ACUTO (IMA) IN SICILIA

Research output: Other contribution

Abstract

[automatically translated] Introduction Adherence to pharmacological therapy in the post-acute phase of AMI has become the subject of growing interest. It has been highlighted, that inappropriate use of drugs is associated with an increased risk of death and of further cardiovascular events. Objectives To assess the adherence to evidence-based drug therapy (EBM) in the 12 months after hospital discharge in a cohort of patients discharged after hospitalization for AMI in Sicily and to assess the possible variability between 9 ASP of the region, taking into account characteristics socio-demographic and clinical severity of patients. Methods Observational study cohort on patients resident in Sicily and discharged from any of the Island hospital with diagnosis of AMI (accidents) in the period 1/12/2010 - 30/11/2011, identified through the SDO. Estimating the consumption of drugs it was inferred from the flow of the pharmaceutical agreement. The investigated drug therapy involves the combined use of drugs affecting the renin-angiotensin system, antiplatelet agents, beta-blockers and statins. Adherence to treatment was calculated according to the proportion of days covered on the basis of daily doses (DDD - Defined Daily Dose) for each drug. Patients were defined members when at least 75% of the total duration of follow-up was found covered with a daily dose of the drug. The outcome in the study, dichotomous, was analyzed by Logistic regression models considering patients' residence ASP as exposure factor and taking into account a number of clinical factors of patients in the study. Results The highest levels of adhesion were observed for statins (76%); followed by drugs acting on the renin-angiotensin system (60%), the antiplatelet agents (52%) and beta-blockers (7.6%). The simultaneous adherence to at least 3 of the 4 groups to study drugs, amounted to 32.43% for the entire region, with a maximum at the ASP of Enna (40%) and a minimum of Ragusa ASP ( 16.38%). The analysis showed some differences by sex and age. The adhesion values in relation to the index of socioeconomic position were higher for the most disadvantaged classes, profit attributable also to a greater use of prescriptions. Among the comorbidities, only cerebrovascular diseases are a risk factor for the outcome in the study (OR = 2.51; 95% CI: 1:41 to 4:46). The remaining clinical variables investigated are inversely associated with the outcome. Conclusion It showed a sub-optimal use of EBM therapy after hospitalization for AMI in Sicily. The percentage of coverage was much lower than that observed in other contexts, regardless of considerati.Inoltre risk factors, the results have shown different percentages of adhesion for the different drugs in question and between different territorial areas.
Original languageItalian
Publication statusPublished - 2014

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