Anti-platelet therapy in diabetic hypertensive patients with and without cardiovascular diseases in Palestine, from 2003 to 2008

Objective

To determine the current frequency of anti-platelet use as indicated in medical charts of diabetic hypertensive patients with and without cardiovascular disease (CVD) using American Diabetes Association (ADA) guidelines compared with use in 2003.

Methodology

Data from both years were collected retrospectively from diabetic hypertensive patients attending government clinics in Nablus district, Palestine. Demographic details and medications were obtained from medical files. Diabetes mellitus and hypertension were confirmed based on documentation of the diagnosis and on listed anti-diabetic and anti-hypertensive medications. Eligibility for anti-platelet therapy was determined with reference to ADA guidelines.

Results

There were 358 patients included in the 2008 study with a mean age of 64.4 years. The mean age of the 342 patients included in the 2003 study was 64.4 ± 8.7 years. Aspirin was the only anti-platelet drug documented in the files in both years. The overall frequency of aspirin listed in 2008 was 66.5% compared to 31.5% in 2003. Among patients with CVD, aspirin therapy for secondary prevention (SP) was found in 77.9% of cases in 2008 compared to 82.4% in 2003 (P = 0.23). Among patients without CVD for whom anti-platelet therapy was indicated, aspirin was listed for primary prevention (PP) in 56.9% of cases in 2008 compared to 17.5% in 2003 (P = 0.001). In 2008, the frequency of aspirin use was independent of gender or age. However, in 2003, the frequency of aspirin use was significantly higher in men and younger patients than in women and elderly patients.

Conclusion

There has been an improvement in anti-platelet therapy using aspirin for primary prevention among high risk patients. No significant change was observed for secondary prevention over the five years. Efforts are needed to enhance the use of aspirin particularly for cardiovascular patients requiring secondary prevention.