38 Chapter 2 This study aimed to summarize evidence on the prevalence of cardioprotective medication use for secondary prevention of CHD in South America. However, most studies were conducted in a limited number of countries and predominantly in Brazil, the largest and most populous country in South America. Our sensitivity analysis showed no prevalence differences between Brazil and the rest of the included countries, though no information was available for Bolivia, Ecuador, Guyana, Paraguay, Peru or Venezuela. As a result, the prevalence estimates of our study may not be generalizable for these countries. Furthermore, we were not able to run meta-regression for several medication classes because there were few observations. We pooled prevalence estimates from the included articles, but the heterogeneity in the from the meta-analysis models was high. We thus presented the results by subgroups and undertook meta-regression models to identify factors associated with medication use, which slightly reduced the heterogeneity of estimates. Conclusion The current systematic review shows large variation in the use of cardioprotective medication among CHD patients in South America, ranging from 55.8% for the use of ACEI/ ARB drugs to 85.1% for the use of aspirin. Medication use was lower in community settings, and it was often considered suboptimal in relation to clinical guidelines. The use of most cardioprotective medication classes has increased in the last 20 years though efforts should be made to further increase the use of these medications among CHD patients, particularly in community settings. ACKNOWLEDGEMENTS The research team is very grateful to Felix Weijdema from Utrecht University Library and Daniel Comandé from Instituto de Efectividad Clínica y Sanitaria Library for their support in drafting the search strategy and using literature databases. The team would also like to thank Dr. Thomas Debray for his methodological advice on meta-analysis and metaregression modelling.
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