Secondary prevention therapies for coronary heart disease in patients with type 2 diabetes: an audit.

BACKGROUND Use of evidence based pharmacotherapy reduces risk of secondary events in patients with established coronary heart disease (CHD). To determine frequency of their use in diabetic CHD we performed prescription audits. METHODS Frequency of prescriptions of aspirin, beta-blockers, angiotensin converting enzymes inhibitors (ACEI) or angiotensin receptor blockers (ARB), lipid-lowering medicines, and other drugs in CHD patients at primary, secondary and tertiary levels of care in out-patients' departments in Rajasthan was determined. Patients' and physicians' demographic details and prescribing patterns were obtained. Descriptive statistics are reported. RESULTS We audited prescriptions of 2290 CHD patients aged 60.9 +/- 8.7 years. There were 1033 patients of CHD with diabetes (45.1%, age 61.9 +/- 8.6) and 1257 without (54.9%, age 59.9 +/- 8.9). In CHD patients with diabetes vs. without, use of beta blockers was lower (59.4 vs 69.2%) while ACEI/ARB (86.5 vs 82.1%) and statins (67.1 vs 59.7%) greater. Use of other drugs such as aspirin (88.7 vs 88.3%), fibrates (11.9 vs 11.1%), non-dihydropyridine CCB (16.0 vs 17.9%) and nitrates (38.8 vs 14.5%) was similar. Use of beta blockers was lowest among diabetologists (37.6%) as compared to other physicians (64.4%) and cardiologists (59.4%) and was the lowest in primary care. CONCLUSIONS Low use of beta-blockers is observed in diabetic CHD patients.