Older physicians and non-cardiologists are less likely to prescribe proven effective medicines for patients that recently sustained a heart attack, according to a study published in this week’s Canadian Medical Association Journal.
Peter Austin and colleagues at the University of Toronto conducted the study. They reviewed administrative data from 132,778 myocardial infarction (heart attack) patients in Ontario between 1992 and 2005.
Overall, the scientists found a heartening rise in utilization of beta-blockers, ACE inhibitors and statins in post-MI patients over the course of the study period. Prescriptions for these medications rose from 42.6%, 42% and 4.2% respectively at the beginning to about 80% for all three groups by 2005.
However, physicians that had practiced medicine for at least 29 years adopted best practices more slowly and in the end were 19% and 29% less likely to prescribe statins and beta-blockers than their younger colleagues.
Similarly, non-cardiologists were 18-54% less likely than cardiologists to discharge patients on these medications.
Medical evidence had established the efficacy of beta blockers by 1992. Final verdicts on ACE inhibitors and statins were nailed down by 1995 and 1998 respectively. In general, these drugs reduce mortality, reduce complications and improve functional status post-MI.
In hospitals having electronic medical records, reminder systems can increase utilization of evidence-based practices. Low-tech solutions such as pre-drafted discharge orders can also work. Post-MI patients should ask physicians about these medications if they don’t receive prescriptions for them.