Statins are recommended for all patients with known coronary heart
disease. This pilot study investigated statin initiation by a Western
Australian general practitioner cohort and the influence of prescriber
and patient characteristics on prescribing.
A structured vignette questionnaire was posted to members of the
Fremantle GP Network. Respondents indicated their prescribing
decisions for nine hypothetical patients who had recently suffered
a myocardial infarction. Data analysis utilised logistic regression
analyses and a generalised linear model with a logit link function.
Fifty-five GPs responded (16.0% response rate). In over 20% of cases
a statin was not prescribed. Male (OR 4.71; 95% CI: 1.24–17.87) and
GPs with fewer years in practice (4.50; 1.21–16.77) were more likely to
prescribe appropriately. Younger patients (2.21; 1.38–3.53), and those
with diabetes (1.74; 1.09–2.76) or hypercholesterolaemia
(4.81; 2.88–8.03) were more likely to receive therapy.
Prescribing practices failed to comply with current guidelines in
a significant number of cases. Further research to confirm these
findings is warranted.
The National Heart Foundation of Australia (NHF) and the Cardiac Society of Australia and New Zealand Reducing Risk in Heart Disease 2007 guidelines state that ‘statin therapy is recommended for all patients with coronary heart disease (apart from in exceptional circumstances)’.1 This recommendation is supported by the results of numerous randomised controlled clinical trials: statins (HMG-CoA reductase inhibitors) have been shown to be of benefit in the secondary prevention of cardiovascular disease in patients with documented dyslipidaemia, those with previously ‘normal’ cholesterol levels and also in elderly patients.2–4 Early initiation of statins in the management of acute coronary syndromes (ACS ) has been proven to offer additional benefits.5,6
Download the PDF for the full article.