Background: Recent results from various studies (EUROASPIRE, SURF) or analyses of national cohorts showed persisting differences between men and women with cardiovascular disease (CVD) in prescription rates of evidence-based medical therapies. To minimize those differences and to improve secondary prevention of CVD in 2004 in Germany a disease management program (DMP) for this chronic condition was established in ambulatory health care. Among others, e. g. reducing blood pressure or smoking cessation, prescription rates of prognostic relevant medications belong to the defined indicators of quality of care, which are presented in semiannual feedback reports to the practices taking part in the DMP.
Purpose: Prescription rates of antiplatelet drugs, beta blockers, ACE inhibitors (ACE-I, in patients with CVD plus heart failure) and statins were analysed in 2008 and 2016. Did those rates increase and did the rates' differences between men and women decrease during that time course?
Methods: Cross sectional analysis of two population cohorts (2008, n=186 599, mean age 70.2±10.3 yrs., male 63.2%, 2016, n=248 471, mean age 72.2±11.1 yrs., male 63.8%), stratified by age and gender, in the North Rhine region, Germany. Logistic regression analyses of the significance of the factor gender (male vs female), controlled for the confounders age, comorbidities, duration of participation, and coronary interventions.
Results: Overall prescription rates showed an increasing tendency which was more pronounced in women (antiplatelet drugs: 77.5 vs. 79.3%, beta blockers: 74.3 vs. 77.7%, ACE-I: 71.1 vs. 74.2%, statins: 64.3 vs. 71.0%, 2008 resp. 2016) than in men (antiplatelet drugs: 84.6 vs. 85.6%, beta blockers: 79.1 vs. 80.2%, ACE-I: 77.0 vs. 78.8%, statins: 74.8 vs. 79.3%). As a result of this tendency differences in prescription rates between men and women decreased (antiplatelet drugs: +7.1 vs. +6.3%, beta blockers: +4.8 vs. +2.5%, ACE-I: +5.9 vs. +4.6%, statins: +10.5 vs. +8.3%, 2008 resp. 2016) but remained comparatively large especially for statins and antiplatelet drugs. In the logistic regression models the factor gender remained statistically significant in 2016 for the prescription of antiplatelet drugs (OR 1.25, CI-95% 1.22–1.28), ACE-Is (1.14, 1.09–1.20), and statins (1.23, 1.20–1.26), but not for the prescription of beta blockers (0.98, 0.96–1.00).
Conclusion: Secondary prevention of CVD improved during the time course of a DMP focusing on the prescription of prognostic relevant medications as indicators of quality of care. Differences in prescription rates between men and women showed a decreasing trend but did not vanish. In 2016 gender was still an important predictor for the prescription of 3 in 4 medications analysed here. These results confirm that it is still a matter of outstanding importance to improve secondary prevention in women with CVD.