Use of Evidence-Based Pharmacotherapy Rising for Most Cardiovascular Conditions

By Reuters Staff

NEW YORK (Reuters Health) - The use of evidence-based medication appears to be increasing for three of four cardiovascular conditions tracked by the U.S. National Cardiovascular Data Registry PINNACLE Registry of outpatient cardiovascular practices.

An overview of the PINNACLE Registry last appeared in 2013 and included data on patients and their care through 2011.

In the current study, Dr. Thomas M. Maddox of Washington University School of Medicine, St. Louis, in Missouri, and colleagues provide updated information through 2017 on patient populations, participating practices, current patterns of care, and adherence to evidence-based measures.

The number of patients in the registry more than doubled, from nearly 2.9 million patients in 2013 to more than 6 million in 2017, the researchers report in the Journal of the American College of Cardiology.

Of the four conditions tracked by the registry, hypertension was most prevalent, followed by coronary-artery disease (CAD), atrial fibrillation (AF), and heart failure (HF).

Among patients with HF, the rate of prescription of evidence-based medications increased from 60.7% in 2013 to 72.8% in 2017 (P<0.001), with significant increases in the prescription of beta blockers (from 75.5% to 88.0%) and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/angiotensin-receptor-neprilysin inhibitors (ACEI/ARB/ARNIs) (66.1% to 78.0%).

For patients with CAD, the combined rate of prescription of antiplatelets, statins, beta-blockers and ACEI/ARB/ARNIs increased from 32% in 2013 to 40.4% in 2017 (P<0.001), including significant increases in beta-blockers (from 63.1% to 72.9%), statins (from 66% to 80.1%) and ACEI/ARB/ARNIs (from 54.5% to 63%).

The rates of prescription of any oral anticoagulants to patients with AF increased from 52.7% in 2013 to 65.2% in 2017. There were significant decreases in warfarin use (from 38.5% to 29.1%) with concomitant increases in direct oral anticoagulant use (from 18.1% to 41.9%).

Rate control was the dominant strategy for symptomatic treatment of AF (increasing from 69% to 80.4% of patients); antiarrhythmic medications were most commonly used when rhythm-control strategies were employed (from 30.2% to 37.1%).

Among patients with hypertension, blood pressure control rates did not change meaningfully between 2013 and 2017. ACEI/ARB were the most popular antihypertensives during this period (from 53.6% in 2013 to 60.3% in 2017), but beta-blockers were also commonly prescribed (from 54.7% in 2013 to 56.5% in 2017).

Despite having a first-line indication for most patients with hypertension, diuretics were less commonly used (32.7% of patients in 2013, 37.9% of patients in 2017).

"The data from 2013 to 2017 indicates that, in most cases, care is improving in PINNACLE Registry practices and becoming more standardized," the authors conclude. "However, it also highlights areas where improvements should occur."

Dr. Maddox did not respond to a request for comments.

SOURCE: https://bit.ly/2t1cHDk Journal of the American College of Cardiology, online January 6, 2020.

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