Secondary prevention of coronary heart disease in older patients after the national service framework: population based study.

OBJECTIVE To examine the extent of uptake of medication for secondary prevention of coronary heart disease in older British men and women before (1998-2001) and after (2003) the implementation of the national service framework. DESIGN Two population based, longitudinal studies of men and women aged 60-79 in 1998-2001, based in one general practice in each of 24 British towns. PARTICIPANTS Men and women with established coronary heart disease at the two time points (respectively 817 and 465 in 1998-2001, 857 and 548 in 2003), aged 60-79 in 1998-2001. MAIN OUTCOME MEASURES Prevalence of use of antiplatelet medication, statins, beta blockers, angiotensin converting enzyme (ACE) inhibitors, and other blood pressure lowering treatments (individually and in combination) assessed in 1998-2001 and 2003. RESULTS Between 1998-2001 and 2003, the use of all individual drugs had increased in both men and women, especially for statins (from 34% to 65% in men and from 48% to 67% in women with myocardial infarction). However, less than half received beta blockers and ACE inhibitors, even by 2003. Prevalences of medication use were lower in patients with angina than in those with myocardial infarction. The proportions of patients receiving more than one drug increased over time; by 2003 about half of patients with myocardial infarction and a third of those with angina were receiving antiplatelet medication, statins, and blood pressure lowering treatments. CONCLUSIONS Between 1998-2001 and 2003, statin uptake and the use of combined drug treatment in elderly men and women increased markedly. Further potential exists, however, for reducing the risk of recurrent coronary heart disease in older patients, particularly by improving the uptake of medication among angina patients, and by more extensive use of blood pressure lowering treatment (particularly with beta blockers and ACE inhibitors).