Trends in secondary prevention of ischaemic heart disease in the UK 1994-2005: use of individual and combination treatment

Background: Statins, antiplatelet drugs, beta-blockers and ACE inhibitors may produce marked benefits in secondary prevention of ischaemic heart disease (IHD), especially in combination. Objective: To examine trends in treatment and factors associated with treatment using a population-based general practice database. Design: Analysis of routinely collected computerised data from 201 general practices using iSOFT software contributing to the DIN-LINK database. Setting and patients: Subjects aged >= 35 years and registered with the practices; on average, 30 000 men and 21 000 women with IHD each year. Main outcome measure: Percentage of subjects with IHD receiving individual drugs and combined treatment in any given year. Results: Between 1994 and 2005 use of drugs for secondary prevention increased markedly. By 2005, 80% of men and 70% of women were receiving a statin, 75% and 74% were receiving antiplatelet drugs, 55% and 48% were receiving beta-blockers and 57% and 51% were receiving an ACE inhibitor; 55% of men and 46% of women were receiving a statin, antiplatelet drug and either beta-blocker or ACE inhibitor, of whom just under half were receiving all four classes of drug. Gender differences were largely explained by more severe disease in men. In 2005, subjects less likely to receive combination therapy were older, had not had a myocardial infarction or revascularisation, and lacked comorbidities such as diabetes or hypertension. Conclusions: Despite high levels of statin and antiplatelet prescribing, opportunities exist for increasing the benefits of secondary prevention, especially through the wider use of combined treatments. Future targets could usefully include combination therapy.