PMID- 37987181
OWN - NLM
STAT- MEDLINE
DCOM- 20240329
LR  - 20240329
IS  - 2047-4881 (Electronic)
IS  - 2047-4873 (Linking)
VI  - 31
IP  - 5
DP  - 2024 Mar 27
TI  - Use of secondary prevention medications in metropolitan and non-metropolitan 
      areas: an analysis of 41 925 myocardial infarctions in Australia.
PG  - 580-588
LID - 10.1093/eurjpc/zwad360 [doi]
AB  - AIMS: People in remote areas may have more difficulty accessing healthcare 
      following myocardial infarction (MI) than people in metropolitan areas. We 
      determined whether remoteness was associated with initial and 12-month use of 
      secondary prevention medications following MI in Victoria, Australia. METHODS AND 
      RESULTS: We included all people alive at least 90 days after discharge following 
      MI between July 2012 and June 2017 in Victoria, Australia (n = 41 925). We 
      investigated dispensing of P2Y12 inhibitors (P2Y12i), statins, 
      angiotensin-converting enzyme inhibitors or angiotensin receptor blockers 
      (ACEIs/ARBs), and beta-blockers within 90 days after discharge. We estimated 
      12-month medication use using proportion of days covered (PDC). Remoteness was 
      determined using the Accessibility/Remoteness Index of Australia (ARIA). Data 
      were analysed using adjusted parametric regression models stratified by ST 
      elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). There were 10 819 
      STEMI admissions and 31 106 NSTEMI admissions. Following adjustment across NSTEMI 
      and STEMI, there were no medication classes dispensed in the 90-day 
      post-discharge that differed in a clinically significant way from the least 
      remote (ARIA = 0) to the most remote (ARIA = 4.8) areas. The largest difference 
      for NSTEMI was ACEI/ARB, with 71% (95% confidence interval 70-72%) vs. 80% 
      (76-83%). For STEMI, it was statins with 89% (88-90%) vs. 95% (91-97%). Predicted 
      PDC for STEMI and NSTEMI was not clinically significant across remoteness, with 
      the largest difference in NSTEMI being P2Y12i with 48% (47-50%) vs. 55% (51-59%), 
      and in STEMI, it was ACEI/ARB with 68% (67-69%) vs. 76% (70-80%). CONCLUSION: 
      Remoteness does not appear to be a clinically significant driver for medication 
      use following MI. Possible differences in cardiovascular outcomes in metropolitan 
      and non-metropolitan areas are not likely to be explained by access to secondary 
      prevention medications.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology. All rights reserved. For permissions, please 
      e-mail: journals.permissions@oup.com.
FAU - Livori, Adam C
AU  - Livori AC
AUID- ORCID: 0000-0002-5337-8061
AD  - Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical 
      Sciences, Monash University, VIC, Australia.
AD  - Grampians Health, Ballarat, VIC, Australia.
FAU - Ademi, Zanfina
AU  - Ademi Z
AUID- ORCID: 0000-0002-0625-3522
AD  - Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical 
      Sciences, Monash University, VIC, Australia.
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      VIC, Australia.
AD  - Monash Data Futures Institute, Monash University, Melbourne, VIC, Australia.
FAU - Ilomaki, Jenni
AU  - Ilomaki J
AD  - Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical 
      Sciences, Monash University, VIC, Australia.
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      VIC, Australia.
FAU - Pol, Derk
AU  - Pol D
AUID- ORCID: 0000-0003-0396-3825
AD  - Latrobe Regional Hospital, Traralgon, VIC, Australia.
FAU - Morton, Jedidiah I
AU  - Morton JI
AUID- ORCID: 0000-0002-3231-5758
AD  - Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical 
      Sciences, Monash University, VIC, Australia.
AD  - Department of Diabetes and Population Health, Baker Heart and Diabetes Institute, 
      Melbourne, VIC, Australia.
FAU - Bell, J Simon
AU  - Bell JS
AUID- ORCID: 0000-0002-6115-2767
AD  - Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical 
      Sciences, Monash University, VIC, Australia.
AD  - School of Public Health and Preventive Medicine, Monash University, Melbourne, 
      VIC, Australia.
AD  - Monash Data Futures Institute, Monash University, Melbourne, VIC, Australia.
LA  - eng
GR  - Victorian Medical Research Acceleration Fund/
GR  - Dementia Australia Research Foundation/
PT  - Journal Article
PL  - England
TA  - Eur J Prev Cardiol
JT  - European journal of preventive cardiology
JID - 101564430
RN  - 0 (Angiotensin Receptor Antagonists)
RN  - 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors)
RN  - 0 (Angiotensin-Converting Enzyme Inhibitors)
SB  - IM
CIN - Eur J Prev Cardiol. 2024 Mar 25;:. PMID: 38527225
MH  - Humans
MH  - *ST Elevation Myocardial Infarction/diagnosis/drug therapy
MH  - *Non-ST Elevated Myocardial Infarction/drug therapy
MH  - Angiotensin Receptor Antagonists/therapeutic use
MH  - *Hydroxymethylglutaryl-CoA Reductase Inhibitors/therapeutic use
MH  - Secondary Prevention
MH  - Aftercare
MH  - Angiotensin-Converting Enzyme Inhibitors/therapeutic use
MH  - Patient Discharge
MH  - *Myocardial Infarction/diagnosis/drug therapy/prevention & control
MH  - Victoria
OAB - We investigated how where a person lives may affect the use of medications 
      required following a heart attack. Our research used dispensing information and 
      hospital admission information for a population of 41 925 heart attack 
      admissions. Our main findings were as follows: There were no clinically 
      significant differences in initial dispensing or 12-month use of secondary 
      prevention medications with respect to how remote a person may live in Victoria, 
      Australia.Our research suggests that there is equal access to medications with 
      respect to remoteness, and any differences in quality of life or life expectancy 
      following a heart attack are unlikely to be driven by differences in access to 
      medications.
OABL- eng
OTO - NOTNLM
OT  - Cardiovascular diseases
OT  - Medication adherence
OT  - Myocardial infarction
OT  - Remoteness
OT  - Secondary prevention
COIS- Conflict of interest: A.C.L., Z.A., D.P., and J.I.M. have no conflicts to declare 
      relevant to this publication. J.I. has received grants from the NHMRC, National 
      Breast Cancer Foundation, Dementia Australia Research Foundation, AstraZeneca. 
      and Amgen. J.S.B. is supported by a National Health and Medical Research Council 
      (NHMRC) Boosting Dementia Research Leadership Fellowship and has received grant 
      funding or consulting funds from the NHMRC, Medical Research Future Fund, 
      Victorian Government Department of Health, Dementia Australia Research 
      Foundation, Yulgilbar Foundation, Aged Care Quality and Safety Commission, 
      Dementia Centre for Research Collaboration, Pharmaceutical Society of Australia, 
      Society of Hospital Pharmacists of Australia, GlaxoSmithKline Supported Studies 
      Programme, Amgen, and several aged care provider organizations unrelated to this 
      work. All grants and consulting funds were paid to the employing institution.
EDAT- 2023/11/21 06:42
MHDA- 2024/03/29 06:46
CRDT- 2023/11/21 05:31
PHST- 2023/08/23 00:00 [received]
PHST- 2023/11/08 00:00 [revised]
PHST- 2023/11/16 00:00 [accepted]
PHST- 2024/03/29 06:46 [medline]
PHST- 2023/11/21 06:42 [pubmed]
PHST- 2023/11/21 05:31 [entrez]
AID - 7438971 [pii]
AID - 10.1093/eurjpc/zwad360 [doi]
PST - ppublish
SO  - Eur J Prev Cardiol. 2024 Mar 27;31(5):580-588. doi: 10.1093/eurjpc/zwad360.