The Role of Physician-Related Characteristics in Prescribing Practices for Secondary Prevention of Myocardial Infarction in Nork Marash Medical Center

Abstract

Background: Cardiovascular diseases are considered to be a serious public health problem both in developing and developed countries. They account for 37% of deaths in the US and 50% of all deaths in Armenia. Myocardial infarction (MI) is a serious medical condition that is caused by a lack of oxygen and/or an inadequate supply of nutrition to the heart. Secondary complications that can occur after myocardial infarction include recurrence of MI which happens in 15-20% of cases; the overall risk of mortality within one year after a primary episode of MI is 25% for men and 38% for women. In order to prevent recurrence of MI after an initial episode, clinical practice guidelines suggest that antiplatelets, β-blockers, ACE inhibitors, and statins should be prescribed. The literature notes that factors including information overload, forgetfulness, poor documentation, and patient load can affect the prescription practices of physicians. The aim of the study was to measure the percentage of patients diagnosed with myocardial infarction that received all recommended drugs following their episode and to explore the effects of physicians’ characteristics on their prescribing practices. Methods: The study was based on two separate data collection activities. The first was a crosssectional survey with all cardiologists that manage post-MI patients in the Nork Marash Medical Center in Yerevan. The second activity was a review of 364 patient records of MI patients that were managed by surveyed physicians. Simple linear regression was used in order to assess the associations between correct pharmaceutical management of these patients and selected physicians characteristics. Results: Correct prescription rates across physicians for anti-platelets, ACE-inhibitors, β- blockers and statins were 92, 76, 85 and 65 percent, respectively. Fifty-two percent of post-MI patients received correct management for all four classes of pharmaceuticals. Rates of correct pharmaceutical management varied widely—from 10 to 75 percent —among individual physicians. Testing for associations between rate of correct pharmaceutical management and physicians’ characteristics revealed (i) a negative association between correct pharmaceutical management of patients and physicians’ positive attitude towards guidelines and (ii) a positive association between the correct prescription of statin and physicians’ perceptions regarding the availability of statins to patients. Conclusions: We found wide variation among physicians in the correct pharmaceutical management rate of post-MI patients. The low sample size limited our ability to detect meaningful associations between correct pharmaceutical management and physicians’ characteristics.