Effect of Optimal Medical Therapy at Discharge in Patients With Reperfused ST-Segment Elevation Myocardial Infarction on 1-Year Mortality (from the Regional RESCUe Registry)

Tomasevic, Danka; Khoury, Carlos El; Subtil, Fabien; Dubien, Pierre-Yves; Bochaton, Thomas; Serre, Patrice; Gueugniaud, Pierre‐Yves; Bonnefoy‐Cudraz, Eric; Mewton, Nathan

doi:10.1016/j.amjcard.2017.11.002

Cited by 12 publications

(11 citation statements)

References 15 publications

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“…GPs are confident with the discharge prescription from specialists. These results show the importance of an optimal prescription at discharge and are supported by the literature, which largely showed an effect of optimal prescription at discharge on 1-year mortality after STEMI [13,20].…”

Section: Discussionsupporting

confidence: 84%

“…We hypothesize that the disparity we found in our results is partly due to this perceived risk of MI recurrence and to the perceived risk of side effects, older patients being more likely to develop side effects due to polypharmacy [26]. However, Tomasevic et al showed recently that the subgroup of older and comorbid patients with ACS benefit from an optimal post-ACS treatment, with a reduction in the 1-year mortality [13].…”

Section: Discussionmentioning

confidence: 60%

“…A recent French study with more than 5000 STEMI patients showed that around 40% of STEMI patients were undertreated [13]. This had clinical consequences, as undertreated patients had significantly higher 1-year mortality.…”

Section: Patient Populationmentioning

confidence: 99%

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Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

Bruggmann

Iglesias

Gex‐Fabry

et al. 2019

Am J Cardiovasc Drugs

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Aim American and European associations of cardiology published specific guidelines about recommended drugs for secondary prevention in ST-segment elevation myocardial infarction (STEMI) patients. Our aim was to assess whether drug prescription for STEMI patients was in accordance with the guidelines at discharge and after 1 year. Method We used data of 361 patients admitted for STEMI in a tertiary hospital in Switzerland from 2014 to 2016. We assessed the adequacy of prescription of recommended drugs at two time points: discharge and after 1 year. Medications assessed were aspirin, P2Y12 inhibitors, statin, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and β-blockers. We took into account several criteria like statin dosage (low versus high intensity) and presence of contraindication for consideration of optimal therapy. Predictors of incomplete prescription of guideline medications were then assessed with multivariate logistic regression models. Results From discharge (n = 358) to 1-year follow-up (n = 303), rate of optimal prescription was reduced from 98.6 to 91.7% for aspirin, from 93.9 to 79.1% for P2Y12 inhibitors, from 83.8 to 65.7% for statins, from 98.6 to 95.6% for ACEIs/ ARBs, and from 97.1 to 96.9% for β-blockers. Predictors of incomplete prescription of guideline medications at discharge were female sex (odds ratio [OR] 2.54, p = 0.007), active or former smoker status (OR 2.29, p = 0.017), multivessel disease (OR 2.07, p = 0.022), left ventricular ejection fraction < 40% (OR 2.49, p = 0.008), and transfer to cardiac surgery (OR 9.66, p = 0.018). At 1 year, age > 65 (OR 1.92, p = 0.036) remained the only significant predictor. Conclusion The present study showed a high prescription rate of guideline-recommended medications in a referral center for primary percutaneous coronary intervention. At discharge, women and co-morbid patients were at the highest risk of incomplete prescription of guideline medications, whereas long-term prescription was suboptimal for elderly. A drug lacking at time of discharge was rarely introduced within the year, which underscores the paramount importance of optimal prescription at time of discharge. Strategies like implementing a standardized prescription could reduce the proportion of suboptimal prescription. It could therefore be one way to improve the long-term quality of care of our patients to the highest level. This study used local data from AMIS Plus-National Registry of Acute Myocardial Infarction in Switzerland (NCT01305785).

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 60%

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Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

Bruggmann

Iglesias

Gex‐Fabry

et al. 2019

Am J Cardiovasc Drugs

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“…Most previous studies observed guideline adherence of preventive medications administered at-discharge [36,37]. Two slightly similar studies looked at a different set of medications in patients with ACS in Vietnam [20] and India [35].…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Association between Adherence to Guideline-Recommended Preventive Medications and In-Hospital Mortality among Non-Reperfused ST-Elevation Myocardial Infarction Patients Admitted to a Tertiary Care Academic Center in a Developing Country

Irawati

Dharma

Taxis

et al. 2020

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Background and aims: Acute ST-elevation myocardial infarction (STEMI) is a potentially fatal presentation of coronary artery disease (CAD). Evidence of the impact of acute pharmacological interventions in non-reperfused STEMI patients on subsequent events is limited. We aimed to assess the association between adherence to guideline-recommended preventive medications and in-hospital mortality among this high-risk patient population. Methods: We conducted a cohort study using data obtained from the Jakarta Acute Coronary Syndrome (JAC) Registry database from a tertiary care academic hospital in Indonesia. We included 1132 of 2694 patients with STEMI recorded between 1 January 2014 and 31 December 2016 who did not undergo acute reperfusion therapy. Adherence to guidelinerecommended preventive medications was defined as the combined administration of aspirin, clopidogrel, anticoagulants and statins after hospital admission. The main outcome measure was in-hospital mortality. Results: Overall, 778 of 1132 patients (69%) received the combination of preventive medications. The guideline non-adherent group had significantly more patients with earlier onset of STEMI, higher Killip class and thrombolysis in myocardial infarction (TIMI) score. After adjustments for measured characteristics using logistic regression modeling, exposure to the combination of preventive therapies was associated with a statistically significant lower risk for in-hospital mortality (adjusted odds ratio: 0.46, 95% confidence interval: 0.30-0.70). Conclusions: Adherence to guideline-recommended preventive medications was associated with lower risk of in-hospital mortality in non-reperfused STEMI patients. The predictors of not receiving these medications need to be confirmed in future research.

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“…Following hospital discharge for AMI, most recent guidelines recommend the concurrent use of drugs from four classes as a secondary prevention measure: 1) an antiplatelet, 2) a beta‐blocker, 3) a lipid‐lowering and 4) an angiotensin‐converting enzyme (ACE) inhibitor or an angiotensin II receptor blocker (ARB) . Prior studies have shown that an optimal use of these guideline‐recommended drugs effectively reduce the risk of recurrence of cardiovascular events and mortality . However, exposure to guideline‐recommended drugs is influenced by the health care system, the disease, patient's beliefs and behaviour, patient's socioeconomic status, along with other factors .…”

Section: Introductionmentioning

confidence: 99%

Exposure to guideline‐recommended drugs after a first acute myocardial infarction in older adults: does deprivation matter?

Akator

Blais

Gamache

et al. 2019

Pharmacoepidemiology and Drug

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Background: Inequities between guideline-recommended drugs (GRD) exposure and socioeconomic status might exist. The objective was to assess the association between a material and a social deprivation index and GRD exposure following a first acute myocardial infarction (AMI) in older adults in the province of Quebec. Methods:We conducted a retrospective cohort study using the Quebec Integrated Chronic Disease Surveillance System. Elderly ≥66 years, hospitalized for a first AMI between January 1, 2006, and December 31, 2011 and covered by the public drug plan were identified. Exposure to GRD (i.e. simultaneous use of 1) antiplatelet, 2) beta-blocker, 3) lipid-lowering and 4) angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker drugs) was assessed 30 and 365 days following hospital discharge. Associations between deprivation index and GRD exposure were estimated with log-binomial regressions adjusting for potential confounders.Results: Exposure to GRD was 52.2% and 48.0%, 30 and 365 days after hospital discharge, respectively. No statistically significant association was observed in multivariate analysis for both time points. Thirty days post hospital discharge, adjusted prevalence ratio of non-exposure to GRD was 0.98 (95% confidence interval [CI]: 0.95-1.02) for most materially deprived vs. least deprived and 1.04 (95% CI: 0.99-1.08) for most socially deprived vs. least deprived. Similar results were observed for 365 days.Conclusion: Exposure to GRD after a first urgent AMI among older adults insured by the public drug plan in the province of Quebec is relatively low. Reasons and risk groups for this low exposure should be studied to improve secondary prevention. However, results suggest equitable access to GRD, regardless of deprivation.

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Effect of Optimal Medical Therapy at Discharge in Patients With Reperfused ST-Segment Elevation Myocardial Infarction on 1-Year Mortality (from the Regional RESCUe Registry)

Cited by 12 publications

References 15 publications

Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

Association between Adherence to Guideline-Recommended Preventive Medications and In-Hospital Mortality among Non-Reperfused ST-Elevation Myocardial Infarction Patients Admitted to a Tertiary Care Academic Center in a Developing Country

Exposure to guideline‐recommended drugs after a first acute myocardial infarction in older adults: does deprivation matter?

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