34 Chapter 2 number of publications reporting on age, SES and cardiovascular risk factors in a comparable format was low and thus they couldn’t be included in the meta-regression. Variable Beta-blockers ACEI-ARB Statin Antiplatlet drugs (overall) Aspirin Intercept 2.56 (0.89-7.37)* 0.84 (0.36-1.94) 3.55 (1.04-12.17) 6.57 (2.60-16.57)* 6.06 (2.18-16.87)* Sex 1.01 (0.98-1.04) 1.01 (0.98-1.04) 1.01 (0.97-1.04) 1.00 (0.97-1.03) 1.00 (0.97-1.03) Setting Primary care / community 0.18 (0.04-0.96)* 0.11 (0.02-0.62)* 0.12 (0.03-0.40)* 0.19 (0.04-0.96) § Public centre 0.35 (0.07-1.69) 0.28 (0.09-0.86)* Cardiac rehabilitation 0.92 (0.30-2.78) 1.87 (0.53-6.61) 0.38 (0.14 – 1.04) 0.07 (0.02-0.33) * Other 0.71 (0.27-1.88) 0.67 (0.27-1.64) 0.73 (0.37-1.44) 1.03 (0.36-2.92) Diagnosis ACS 1.41 (0.78-2.54) 1.65 (0.90-3.03) 1.73 (0.89-3.37) PCI 0.70 (0.21-2.28) 0.92 (0.30 – 2.82) 0.94 (0.29-3.08) CABG 1.21 (0.43-3.37) 0.85 (0.27 – 2.65) CABG, PCI 0.58 (0.11-2.97) 1.26 (0.38-4.21) 1.31 (0.37-4.64) Table 3. Results of the meta-regression models showing factors independently associated with medication use. Note: Results are expressed in odds ratios and 95% confidence intervals. Sex was treated as a numerical variable (percentage of women included in the study). The reference category for setting was “AcademicTertiary Hospital”, and the reference category for diagnosis was “coronary heart disease”. Abbreviations: acute coronary syndrome (ACS), coronary artery bypass graft (CABG), CHD, percutaneous coronary intervention (PCI percutaneous coronary intervention). §p=0.05. DISCUSSION Summary of main findings The current systematic review shows large variation in the use of cardioprotective medication among CHD patients, ranging from 55.8% for the use of ACEI/ARB drugs to 85.0% for the use of aspirin. A similar number of studies reported suboptimal and adequate guideline compliance. Time-trend analysis for the period 1993 to 2017, showed an increase in the use cardioprotective medication with the exception of the use of all antiplatelet drugs and aspirin. Use of beta-blockers, statins, overall antiplatelet drugs and aspirin in community settings was lower compared to academic and tertiary centres. The use of antiplatelet drugs
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