Key result
Only ~35% of patients with prior CHD receive guideline-directed secondary prevention, with lowest uptake in women.
Why the study?
Coronary heart disease remains a major cause of mortality worldwide and in Brazil, where guideline-directed medications prevent new events and reduce early mortality, but their utilization patterns needed evaluation.
How is the use of guideline-recommended secondary prevention medications for coronary heart disease associated with baseline sociodemographic characteristics and time since the coronary event in the ELSA-Brasil cohort?
Cross-Sectional (n=15,094)
Yes
How is the use of guideline-recommended secondary prevention medications for coronary heart disease associated with baseline sociodemographic characteristics and time since the coronary event in the ELSA-Brasil cohort?
This study demonstrates substantial underuse of guideline-recommended secondary prevention medications for coronary heart disease in Brazil (~35% adherence to combination therapy), with pronounced disparities affecting women and lower-income patients.
Answers are grounded in this paper and cite their sources.
Suboptimal secondary prevention medication use in prior CHD warrants local quality audits; leaves open causal factors and targeted interventions in Brazil.
BACKGROUND: Coronary heart disease (CHD) remains a major cause of mortality worldwide and in Brazil. Use of standard medications after CHD has been proven to avoid new events and reduce early mortality. OBJECTIVES: This study aimed to analyze secondary prevention of CHD and its association with the baseline characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). DESIGN AND SETTING: Cross-sectional analysis on ELSA-Brasil data. METHODS: Secondary prevention of CHD recommended in standard guidelines (antiplatelet plus beta-blocker plus lipid-lowering drug, with or without angiotensin-converting enzyme inhibitors, ACEI, or angiotensin receptor blockers, ARB) was evaluated in relation to sociodemographic data and the time since the coronary event. The chi-square test, one-way analysis of variance (ANOVA) and Mann-Whitney test were performed, as necessary. RESULTS: Among 15,094 participants, 2.7% reported a previous diagnosis of CHD. Use of recommended drugs for secondary prevention was reported by almost 35% of the participants. Medication use for secondary prevention was generally more frequent among high-income participants than among low-income participants. Use of ARB and ACEI was different between participants who had private health insurance and those who only used the public healthcare system. Men were more likely to use medication than women. The frequency with which participants used the recommended drugs was similar in all time periods after CHD, but use of only one drug increased progressively across time periods. CONCLUSION: The use of medication for secondary prevention of CHD was lower than what is recommended in standardized guidelines, especially among women and lower-income participants.
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Birck et al. (2019) conducted a cross-sectional in Coronary heart disease (CHD) (n=15,094). Sociodemographic characteristics and time elapsed since coronary heart disease event vs. Different socioeconomic, sex, health insurance, and time-since-event strata was evaluated on Use of guideline-recommended secondary prevention medications (antiplatelet plus beta-blocker plus lipid-lowering drug, with or without ACEI or ARB). Guideline-recommended secondary prevention medication combinations were used by only about 35% of participants with prior CHD, with lower use among women and lower-income individuals.
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