The usefulness of antiplatelet prescriptions for the identification of patients with atherothrombosis in primary care: a Dutch cross-sectional study

• Published in: Journal of evaluation in clinical practice Vol. 18; no. 4; pp. 866 - 871
• Main Authors: van de Steeg-van Gompel, Caroline H. P. A., Wensing, Michel, Braspenning, Jozé, De Smet, Peter A. G. M.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01-08-2012
• Subjects: Aged; cardiovascular disease; Cardiovascular Diseases - diagnosis; Cardiovascular Diseases - physiopathology; Cross-Sectional Studies; diagnosis; Drug Prescriptions - statistics & numerical data; drug therapy; Female; General Practice; Humans; Logistic Models; Male; Medical Audit; Middle Aged; Netherlands; patient identification; platelet aggregation inhibitors; Platelet Aggregation Inhibitors - therapeutic use; Primary Health Care; Thrombosis - diagnosis; Netherlands
• ISSN: 1356-1294; 1365-2753
• DOI: 10.1111/j.1365-2753.2011.01697.x

Rationale, aims and objectives  Patients with atherothrombotic cardiovascular disease (ACD) should receive specific treatments, including lipid‐lowering medication. In order to optimize treatment for patients with ACD in primary care, an efficient method to identify all these patients is needed. We aimed to assess which method serves best to identify all patients with ACD in Dutch primary care: morbidity records, antiplatelet prescribing records or a combination of these.
Methods  In a cross‐sectional study in 45 Dutch general practices, computerized medical records of all patients with any cardiovascular disease, cardiovascular symptoms or cardiovascular medication were analysed.
Results  Of the 7280 patients with a recorded indisputable indication for antiplatelet therapy, 4715 (64.8%) could be identified by means of antiplatelet prescriptions. Of the patients with a recorded indisputable indication for antiplatelets but without any antiplatelet prescription, 28.9% received a vitamin K antagonist. Of the 8718 patients with antiplatelet therapy, 5697 (65.3%) could be identified by means of a recorded indisputable or possible indication for antiplatelet therapy. Female patients, patients younger than 60 years old and patients having a recorded diagnosis of angina pectoris or diabetes had a higher risk to be missed by antiplatelet prescribing records.
Conclusion  Morbidity records and prescribing records should be used both in order to identify all patients with ACD in primary care. Patients who use antiplatelet prescriptions but do not have a recorded ACD deserve extra attention, because they are either treated without a good indication for antiplatelet therapy (overtreatment) or need a correction of their morbidity records.