Association Between the Use of 4 Recommended Drug Categories and Patient Perceptions of Health Status Following an ACS Event

BACKGROUND: Four categories of medication have been shown to reduce mortality following an acute coronary syndrome (ACS) event: (a) antiplatelets, (b) beta-blockers, (c) statins, and (d) angiotensin-converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs). OBJECTIVES: To determine the association between use of 1 or more of 4 categories of evidence-based medications and patient-perceived health status. METHODS: Data from the registry of a large university-based health system were used for an analysis of prescribing at discharge following an inpatient hospitalization for ACS. Use of evidence-based medications and patient perceived health status were measured in a telephone survey administered 6 to 12 months (mean [SD]=10 [3.5] months) after hospital discharge. Surveys were conducted from January 2002 through March 2005. Subjects were included in the survey if they were prescribed at least 1 of the 4 evidence-based drug categories at the time of discharge. Each patient was assigned to 1 of 5 groups (range: 0 to 4) based on the number of drug categories self-reported by the patient as current at the time of the survey. Patient-perceived health status was assessed using the question “How would you rate your health at the present time?” using a 5-point scale from excellent (1) to poor (5). Mean perceived health status scores for each of the 4 evidence-based medication categories were compared using Analysis of Variance (ANOVA). Multivariate logistic regression determined the association between patient-perceived health status—dichotomized to excellent/ very good/good versus fair/poor—and the evidence-based medication group, controlling for patient demographics and comorbidities. P values of less than 0.05 were considered statistically significant. RESULTS: A total of 393 of 1,206 patients (32.6%) responded to the survey between 6 and 12 months after discharge for an ACS event. The mean (SD) patient-perceived health status ranged from 3.3 (1.1) for patients with no (0) self-reported evidence-based medications (n=14) to 2.5 (1.0) for patients with 4 evidence-based medications (n=130, P=0.028), indicating higher self-perceived health status for patients who were taking more of the evidence-based medications. Using patients with no (0) evidence based medications as the comparator, the odds of higher patient-perceived health status were multiplied by 8.2 (95% confidence interval [CI]=1.7- 37.9, P=0.007) for those with 4 medications, 9.3 (95% CI=2.0-43.4, P=0.004) for those with 3 medications, 4.9 (95% CI=1.1-22.6, P=0.041) for those with 2 medications, and not significantly different for those with 1 medication (odds ratio=2.5, 95% CI=0.4-14.4, P=0.316). Younger age, prior myocardial infarction, and recurrent ACS events occurring between discharge and the survey date were significantly associated with poorer perceived health status. CONCLUSIONS: Better patient-perceived health status was associated with use of a greater number of evidence-based medications for patients with ACS.