Care pathway in patients after myocardial infarction in Denmark − healthcare and drug utilization

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Incident myocardial infarction (n=24977). Intervention: Post-myocardial infarction follow-up care and lipid lowering therapy. Primary outcome: Frequency of LDL-C measurements, contacts with healthcare actors, and lipid-lowering therapy utilization during the 365 days following discharge.

Q: What does this research mean for the field?

One year after myocardial infarction, 87% of patients had an LDL-C measurement and 87% redeemed statin therapy at least once, demonstrating that a substantial proportion of patients are not monitored or treated according to clinical guidelines. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Marius Mølsted Flege; Theresa Kleinschmidt; Susanne Hansen; Kristoffer Jarlov Jensen; Henrik Kjærulf Jensen; Morten Krogh Christiansen; Charlotte Ottar Merland; Janne Petersen

doi:10.1016/j.ijcha.2025.101809

September 24, 2025IJC Heart & VasculatureOpen Access

Care pathway in patients after myocardial infarction in Denmark − healthcare and drug utilization

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Key result

One year after hospital discharge for an incident myocardial infarction, 87% of patients received at least one LDL-C measurement and 87% redeemed a statin prescription, while ezetimibe use was 16%.

Figures

Graphical abstract published by IJC Heart & Vasculature — Graphical abstract · Published by IJC Heart & Vasculature · CC BY-NC-ND

Why the study?

Many patients fail to reach sufficient LDL-C levels post-MI despite its importance in preventing recurrent events, prompting an evaluation of follow-up and lipid-lowering therapy utilization one year post-MI.

Key Points

To evaluate healthcare contacts, cholesterol monitoring, and the utilization of lipid lowering therapies during the first year following discharge for an incident myocardial infarction.
Nationwide Danish observational register-based study including 24,977 hospitalized patients with incident myocardial infarction discharged alive between 2018 and 2021.
Tracked low-density lipoprotein cholesterol measurements, outpatient cardiology and general practitioner contacts, and lipid lowering drug redemptions over a 365-day follow-up.
Within 365 days post-discharge, cumulative incidence of having low-density lipoprotein cholesterol measured once and twice reached 87 % and 67 %, while 66 % visited a cardiology department, 70 % visited a general practitioner with a cholesterol measurement, and 48 % had an acute contact.
Follow-up with cholesterol measurement or cardiology visits was less likely among patients aged ≥75 years (HR 0.73, CI 0.71–0.76) and females (HR 0.89, CI 0.87–0.92), but higher in those with higher education (HR 1.14, CI 1.1–1.18).

Study Design

Type

Observational (n=24,977)

Multicenter

Yes

Structured PICO

P

Population

24,977 adults hospitalized with an incident myocardial infarction and discharged alive in Denmark, followed for 1 year to assess care pathways and lipid-lowering therapy utilization.

O

Outcome

Frequency of LDL-C measurements, contacts with different healthcare actors, and lipid-lowering therapy (LLT) utilization during the 365 days following discharge with MI.

Limitations

A restructuring of the Danish National Patient Register at the end of 2018 may have caused data gaps.
Misclassification of information could potentially influence results in registry-based data.
No information was available about the department ordering the LDL-C measurement.
Disregarding LDL-C measurements from day 7 to day 30 might lead to a slight underestimation of the frequency of LDL-C measurement.
The study period included the COVID-19 pandemic years, which may have disrupted routine monitoring and treatment.
A restructuring of the DNPR at the end of 2018 may have caused data gaps
Misclassification of information typical of registry-based epidemiologic studies
No information about the department ordering the LDL-C measurement
LDL-C measurements from day seven to day 30 after hospitalization were disregarded
Disruptions in monitoring and treatment due to the COVID-19 pandemic

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Implication

While primary statin use is high among post-myocardial infarction patients, there are significant gaps in specialized follow-up care and the utilization of combination lipid-lowering therapies like ezetimibe.

Abstract

Background: Following myocardial infarction (MI), patients are recommended to lower their low-density lipid cholesterol (LDL-C) levels and undergo cardiac rehabilitation to prevent recurrent events. Although lowering LDL-C is vital post-MI, many patients fail reaching sufficient levels, resulting in recurrent cardiovascular events. The aim of the study was therefore to investigate the follow-up and the utilisation of lipid lowering therapy one year after MI. Methods: This register-based nationwide Danish observational study included all hospitalized patients with an incident MI from 2018 to 2021, discharged alive. Patients were followed for one year after discharge with respect to LDL-C measurements, contacts with different healthcare actors, and lipid lowering therapy. Results: A total of 24,977 patients were included. During follow-up, the incidence of having an LDL-C measured once and twice were 87 % and 67 %, respectively. The incidence of patients visiting a cardiology department, general practitioner with an LDL-C measurement, and having an acute hospital contact were 66 %, 70 %, and 48 %. Statin therapy was redeemed by most patients at least once (87 %) or twice (82 %), while ezetimibe (16 %) and other drugs were prescribed less frequently. Younger, higher educated, less comorbid males with LDL-C ≥ 1.4 mmol/L at hospitalization were more likely to be followed-up with LDL-C measurement or visit to a cardiology department post-MI. Conclusion: These findings show that a large proportion of patients are not receiving lipid lowering therapy or are not monitored according to guidelines one year after an MI. This suggests a further need for monitoring MI patients with LDL-C levels and healthcare visits.

Discussion

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Cite This Study

Flege et al. (2025) conducted an observational in Incident myocardial infarction (n=24,977). Post-myocardial infarction follow-up care and lipid lowering therapy was evaluated on Frequency of LDL-C measurements, contacts with healthcare actors, and lipid-lowering therapy utilization during the 365 days following discharge. One year after hospital discharge for an incident myocardial infarction, 87% of patients received at least one LDL-C measurement and 87% redeemed a statin prescription, while ezetimibe use was 16%.

synapsesocial.com/papers/6a1d63e51e7099f691055bad https://doi.org/10.1016/j.ijcha.2025.101809

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Care pathway in patients after myocardial infarction in Denmark − healthcare and drug utilization

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Care pathway in patients after myocardial infarction in Denmark − healthcare and drug utilization

Figures

Key Points

Study Design

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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