Determinants of use of medications for the secondary prevention of cardiovascular disease

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PROJECT AIMSThe aim of my research is to analyse the current pharmacological management of cardiovascular disease (CVD) in the UK by estimating the degree of suboptimal cardioprotective drug use, as well as the variations in the uptake of interventions across socio-economic groups. Using NHS Scotland and UK Biobank data, the research seeks to examine recent trends in drug use for the secondary prevention of CVD in the UK. The project will also analyse whether the prescription rate and/or usage of preventive drugs decreases with greater social deprivation, and whether the abolition of prescription charges in Scotland has had an impact on cardiovascular medication use. The second part of this study seeks to investigate the role of patient and prescriber characteristics in the underutilisation of cardiovascular medications by studying their relevance to the uptake of treatment in high-risk patients. My research will build on Achelrod and et al.'s (2016) study on Cholesterol- and blood-pressure-lowering drug use for secondary cardiovascular prevention in 2004-2013 Europe, extending research to the UK. In view of the widening socio-economic inequalities in CVD-related mortality in the UK1, the study will hypothesise that individuals who do not take up treatment will significantly differ from treated patients in terms of socio-economic and lifestyle risk factors. The general research question investigates the characteristics of individuals with CVD, who use/do not use drugs for the secondary prevention of CVD. Sub-questions examine the extent to which socio-economic, behavioural and cognitive factors predict medication prescription, initiation and adherence. Third, the research will study whether cardioprotective interventions are compliments or substitutes of health behaviours in different categories of patients. As such, I will explore aspects of Becker's (2007) extended theoretical model of health as human capital that could inform the estimated interaction between health behaviours and preventive drug use. The general research question addressed is: do individuals change their health behaviours when initiating cardiopreventive treatment?IMPORTANCE OF RESEARCH This research addresses a number of gaps in literature by using recent data to conduct the first in-depth analysis on the current situation and determinants of cardiovascular medication use for the secondary prevention of CVD in the UK and to compare the findings with published work from other European countries. As such, this study will provide significant insight on the current barriers to CVD prevention and risk factors of suboptimal drug use. The findings will support novel effective policies for treatment amelioration and lifestyle management that are urgently needed given the high burden and costs of CVD. REFERENCES [1] Bajekal et al., PLoS One 8(3), (2013).