Trends in the Incidence and Management of Acute Myocardial Infarction From 1999 to 2008: Get With the Guidelines Performance Measures in Taiwan

Abstract

BackgroundThe American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan.Methods and ResultsWe used the Taiwan National Health Insurance Research Database (1999–2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age‐adjusted incidence of AMI (/100 000 person‐years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline‐based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin‐converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β‐blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in‐hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, β‐blocker, and statin use during hospitalization were all associated with reduced in‐hospital mortality in our AMI patients.ConclusionsAMI incidence was increasing, but the guideline‐based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.

Analysis of the Clinical Characteristics, Management, and Causes of Death in Patients with ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention from 2005 to 2014

“…14,15) The overall all-cause mortality was 9.1% in this unselected all-comers study, and this did not vary over time. This mortality rate is lower than that of Taiwan whole country data, 12.3% in 2008, 1) and is similar to the mortality rate reported in other high-grade primary PCI-capable hospitals in Taiwan. 16,17) It is also comparable to the data reported from Japan and other countries.…”

“…1) In acute ST-segment elevation myocardial infarction (STEMI), timely primary percutaneous coronary intervention (PCI) and the use of evidence-based medications significantly decrease mortality, and are strongly recommended in local 2) and international guidelines. 3,4) In Taiwan, more than 95% of STEMI patients received primary PCI as the initial reperfusion therapy, and the door-to-balloon (D2B) time has improved.…”

Age-Specific Trends in the Incidence and In-Hospital Mortality of Acute Myocardial Infarction Over 30 Years in Japan — Report From the Miyagi AMI Registry Study —

“…These declines in the incidence of AMI are considered to be attributed to the reduction in the prevalence of coronary risk factors such as hypertension, dyslipidemia, and smoking. 9, 10 In contrast, in Asian countries, together with westernization of diet and lifestyle and societal aging, increasing trends in the age-adjusted incidence of AMI have been reported in Taiwan (from 1999 to 2008) 12 and Korea (from 1997 to 2007). 13 However, the latest study in Korea found that the age-adjusted incidence of AMI turned to decline between 2006 and 2010, 27 which could be caused, at least in part, by preventive care programs and projects for chronic illnesses and cardio-cerebrovascular diseases towards the 2000 s in Korea.…”

Sialyltransferase7A, a Klf4-responsive gene, promotes cardiomyocyte apoptosis during myocardial infarction

“…Myocardial infarction (MI) is the most common reason for heart failure and is one of the most prevalent causes of morbidity and mortality worldwide [26,47]. The cardiomyocyte apoptosis and necrosis that follow MI lead to the loss of cardiomyocytes, which substantially decreases the pumping of the heart and results in congestive heart failure [18,43].…”