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Title: Geographic variation in secondary prevention medication adherence and subsequent outcomes following percutaneous coronary intervention.
Author: Selkrig, L.
Andrianopoulos, Nick
Brennan, A.
Reid, C.
Nanayakkara, S.
Dart, A.
Warren, J.
Sharma, Anand
Ajani, A.
Clark, D.
Freeman, M.
Walton, T.
Duffy, S.
Issue Date: 2017
Conference Name: 65th Cardiac Society of Australia and New Zealand Annual Scientific Meeting and the International Society for Heart Research Australasian Section Annual Scientific Meeting.
Conference Date: August 10th- 13th
Conference Place: Perth, Australia
Abstract: Background: Variation in access to percutaneous coronary intervention (PCI), specialist medical care, pharmacy and cardiac rehabilitation occurs across Australia. We explored the relationship between geographic location, medication adherence and long-term outcomes in patients undergoing PCI. Methods: We assessed 18,421 patients across six hospitals between August 2009 and December 2016 within the Melbourne Interventional Group registry. Patients were classified according to their place of abode as metropolitan, regional or remote utilising the ‘Cardiac Accessibility Remoteness Index Australia’ classification. Medication adherence was defined as optimal medical therapy (OMT), near-optimal medical therapy (NMT; 4 guideline-indicated medications) and sub-optimal medical therapy (SMT; ≤3 guideline-indicated medications). Results: During the study period 13,517 metropolitan, 3,990 regional and 914 remote patients underwent PCI. PCI indication was more commonly ACS for metropolitan patients (66%) vs. regional (59%) and remote (58%). Regional and remote patients were more likely to receive fibrinolysis and a bare-metal stent. Metropolitan patients were older, with more diabetes and multi-vessel disease, however there were fewer current and former smokers. Twelve-month target vessel revascularisation and MACE were higher in the regional and remote cohorts. However, National Death Index linkage demonstrated no difference in long-term mortality between geographic cohorts. Thirty-day medication adherence was similar among geographic cohorts. However, thirty-day NMT and SMT were associated with higher long-term mortality than OMT, as was 12-month SMT. Conclusions: Regional and remote patients undergoing PCI experience similar long-term outcomes as metropolitan patients. Medication adherence is associated with long-term mortality, but prescribing practices are comparable amongst metropolitan, rural and remote patients.
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Internal ID Number: 01304
Type: Conference
Appears in Collections:Research Output

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