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Prescribing drugs for cardiovascular disease prevention in the UK

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Drugs such as statins that have the potential to prevent strokes and other types of cardiovascular disease have not been prescribed to a large proportion of people at risk in the UK, according to a research article by Grace Turner of the University of Birmingham, Birmingham, UK and colleagues published in PLOS Medicine.

Turner and colleagues studied data from THIN, a database that includes anonymized primary care health information for about 6% of the UK population. In an analysis of data from 29,043 people who had suffered a first-ever stroke or transient ischaemic attack during the period January 2009-December 2013, the authors compared the proportion of people prescribed one of three classes of drugs able to prevent strokes with the proportion of people who had a clinical need for one or more of the drugs. Among the patients, 17,680 were eligible to be prescribed at least one of the classes of drugs studied at the time of their stroke or transient ischaemic attack. The data indicate that 49% (7,836/16,028) of the patients were not prescribed a clinically-indicated lipid-lowering drug, such as a statin, 25% (1,740/7,008) were not prescribed anti-hypertensive drugs, and 52% (1,647/3,194) were not prescribed anticoagulant drugs.

In this study, the reasons for drugs not being prescribed to individual patients–which could include those refusing medication — were not available. However, the authors' findings suggest that improved prescribing could potentially avert up to 12,000 strokes per year in the UK.

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Funding:

The study was funded by the National Institute for Health Research School for Primary Care Research (NIHR SPCR). TM was partly funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for West Midlands (CLAHRC-WM). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing Interests:

GMT reports grants from National Institute for Health Research (NIHR) School for Primary Care Research (SPCR), during the conduct of the study; TM reports funding from the NIHR through the Collaborations for Leadership in Applied Health Research and Care for West Midlands (CLAHRC-WM); MC reports funding from European Society of Cardiology & AFNET, and personal fees from Astellas Pharma, outside the submitted work. KC reports grants from Pfizer China, outside the submitted work. MGF and RR have nothing to disclose.

Citation:

Turner GM, Calvert M, Feltham MG, Ryan R, Fitzmaurice D, Cheng KK, et al. (2016) Under-prescribing of Prevention Drugs and Primary Prevention of Stroke and Transient Ischaemic Attack in UK General Practice: A Retrospective Analysis. PLoS Med 13(11): e1002169. doi:10.1371/journal.pmed.1002169

Author Affiliations:

Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom

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http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002169

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Grace Turner
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http://www.plos.org

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