While use of preventive medications like statins, RAAS inhibitors and platelet inhibitors is high in patients early after CABG surgery, the rate of use decreases significantly over time, according to findings from a SWEDEHEART Registry analysis presented at ESC Congress 2019.

The registry analysis included 28,812 patients who underwent isolated first-time CABG in Sweden from 2006 to 2015 and were alive six months after hospital discharge. Median follow-up was five years.

At six months after discharge, data showed statins were dispensed to 93.9 percent of patients, beta-blockers to 91.0 percent, RAAS inhibitors to 72.9 percent, and platelet inhibitors to 93.0 percent of patients. Eight years later the percentages had decreased dramatically to 77.3 percent, 76.4 percent, 65.9 percent and 79.8 percent, respectively. The study did not distinguish between reasons for not using the drugs.

In other findings, researchers observed no major differences in the use of medications between women and men. However, they did note that all drugs were dispensed less frequently to patients over the age of 75.

Erik Bjoerklund, MD, who presented the results, called the observed decrease in prescribing "alarming," given that use of statins, RAAS inhibitors and platelet inhibitors are associated with significantly lower relative risks of mortality at 44 percent, 22 percent and 26 percent, respectively. He noted that no association was found between use of beta-blockers and mortality risk, due to limited published research data.

"The reason behind the fall in medications over time could be that in Sweden many CABG patients are not routinely seen by cardiologists beyond six to 12 months after the operation. Another factor may be that CABG relieves symptoms, so patients feel healthy and their motivation to use multiple daily medications wanes over the years," Bjoerklund said. "The role of long-term treatment with beta-blockers to improve survival after CABG needs to be further investigated."

Keywords: ESC 19, ESC Congress, Secondary Prevention, Coronary Artery Bypass

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