Trends in long‐term management of survivors of acute myocardial infarction by cardiologists in a government university‐affiliated teaching hospital

Abstract

SummaryBackground: Despite prospective randomized control trials showing that beta blockers, aspirin, angiotensin-converting enzyme (ACE) inhibitors, and lipid-lowering agents improve survival rates after myocardial infarction (MI), these agents are routinely underutilized.Hypothesis: Our aim was to determine the frequency with which cardiologists at a government, university-affiliated teaching hospital prescribe aspirin, beta blockers, ACE inhibitors, calcium-channel blocking agents (CCBs), and lipidlowering agents in patients post MI. The patients were followed by their primary care physicians in this hospital after discharge. We evaluated changes in patients' medical management at an average of 24 months after discharge from the acute event.Methods: Clinical data relative to long-term use of life-saving drugs in 156 survivors of definite MI (WHO criteria) at a government, university-affiliated teaching hospital were analyzed over a 24-month follow-up period.Results: Over 90% of patients with acute MI were given aspirin and beta blockers at discharge. About 50% of these patients were given ACE inhibitors, only 25% were prescribed CCBs, and 21% were given lipid-lowering agents. At 24 months of follow-up, the percentage of patients receiving aspirin, beta blockers, and ACE inhibitors had fallen to 88% (p = 0.0408), 71% (p < 0.0001), and 43% (p = 0.1122), respec-

Use and adherence to beta‐blockers for secondary prevention of myocardial infarction: who is not getting the treatment?

“…Butler's study 23 showed that about 61% of patients still collected their beta-blocker prescriptions 1 year following their MI. But in Mitra's study, 24 of 156 AMI patients discharged from a government Universityaffiliated teaching hospital on beta-blocker treatment 71% patients were still on beta-blocker treatment after 2 years follow-up. The difference in adherence to betablocker treatment between different studies may be explained by different population characteristics, prescribing habits or health care systems or different measurements of adherence.…”

Long-Term Adherence to Evidence Based Secondary Prevention Therapies after Acute Myocardial Infarction

“…7,9,10,21,22 Yet, in our study population, there is no sign of leveling in the discontinuation rates after 1 year post-AMI. We identified two studies examining adherence beyond the first year post-AMI, 8,11 which have limited generalizability, and more importantly, examine Figure 2. Time to discontinuation for ACEI/ARB therapy patterns from the 1990s, generally focusing on beta-blockers.…”

“…4 Limited data suggest that many patients who initiated these regimes after AMI have low rates of longterm persistence. [7][8][9][10] Beta-blocker or ACEI therapies are indicated for other diseases (e.g., coronary artery disease and hypertension), and studies following patients with such conditions also demonstrated low long-term adherence rates. [10][11][12][13][14][15] To identify subpopulations at greatest risk of therapy discontinuation, this study used administrative data from a large U.S. health plan to describe patient characteristics and comorbidities associated with increased rates of therapy discontinuation during the 2 years after AMI.…”

Medication adherence after myocardial infarction: A single center retrospective cohort study

“…Discharge prescriptions and content of these prescriptions are considered as the main criteria of success in patients with acute coronary syndrome [1]. A limited number of data indicate that these prescriptions are written appropriately, but in time patients' compliance with these prescriptions is reduced [2][3][4][5]. After acute MI (myocardial infarction), 24% of the patients do not take all of their medications during the first week of discharge and 1/3 of them leave at least 1 drug in one month [6][7].…”

“…) kullanan hastaların oranı % 78.7'di (n=325). İlk yılın sonunda, ASA, statin, beta bloker, anjiyotensin dönüştürücü enzim inhibitörleri / aldosteron reseptör bloker (ADEİ / ARB) ve klopidogrel kullananların oranı sırasıyla; % 88.1'e (n=364), % 66'ya (n=273), % 80.9'a (n = 334),% 69.7'ye (n=288) ve % 81 3…”