Highlights
- •Quality improvement actions for drug therapy after AMI have worked sufficiently.
- •Concomitant use of the recommended drug classes 6 years after AMI was high.
- •Drug therapy was associated with hospital treatment and patients' comorbidities.
- •High polypharmacy rate in AMI survivors requires check for drug interaction.
Abstract
Background
Prior studies reported high guideline adherence for secondary prevention medications
(SPM) at hospital discharge in patients with acute myocardial infarction (AMI). Less
is known about medication use in long-term AMI survivors.
Methods
Of the 2077 registered persons with an AMI between 2000 and 2008 who responded to
a postal follow-up survey in 2011, 1311 men and 356 women, aged between 34.4 and 84.9 years, reported medication intake 7 days prior to the survey. These study participants also had their current health condition
and comorbidities assessed. Information regarding index AMI was selected from the
population-based MONICA/KORA MI registry. Multivariable logistic regression models
were conducted to identify factors associated with SPM use (all 4 drug classes).
Results
The median time between index AMI and the follow-up survey was 6.1 years (IQR: 3.9). At follow-up, a total of 10,422 medications were reported and polypharmacy
was observed in 73.8%. Regarding SPM, the proportion of patients taking antiplatelet
agents, beta-blockers, statins, and renin-angiotensin-aldosteron system blockers were
90.9%, 86.7%, 85.4%, and 79.3% respectively. Factors associated with SPM use were
hypertension (odds ratio [OR] 1.48, p = 0.006), SPM prescription at hospital discharge (OR 2.68, p < 0.0001), revascularization therapy at index AMI (OR 2.46, p > 0.0001), number of medications taken at follow-up (OR 1.48, p < 0.0001), and several comorbidities such as lung disorders (OR 0.17; p < 0.0001), depression (OR 0.53, p = 0.001), neurological disorders (without stroke) (OR 0.34, p = 0.002), and cancer (OR 0.45, p = 0.005).
Conclusion
SPM use several years after AMI was high and associated with treatment at index AMI
and patients' comorbidities.
Keywords
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Article info
Publication history
Published online: August 18, 2017
Accepted:
August 10,
2017
Received in revised form:
July 11,
2017
Received:
April 18,
2017
Footnotes
☆Conflicts of interest of all authors: none, except for CT, see COI statements.
☆Funding: none.
☆Authorship: All authors had access to the data and played a role in writing the manuscript.
Identification
Copyright
© 2017 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
