Conformity with guideline-directed medical therapy and clinical outcomes in secondary cardiovascular prevention—results of a German claims data analysis

AIMS: Clinical guidelines for secondary cardiovascular (CV) prevention provide recommendations for medical treatment to improve patient prognosis. This retrospective German study aimed to identify the level of guideline implementation in patients suffering from myocardial infarction (MI), stroke or transient ischemic attack (TIA), and the impact of guideline-directed medical therapy (GDMT) adherence on CV outcomes or death. METHODS: Data from an anonymized claims dataset from a German statutory health fund were analyzed regarding GDMT for the above patient population. Patients were followed for at least one year after their first MI and/or stroke/TIA. For clinical outcomes analysis, a 1:1 propensity score matching (PSM) was applied between patients receiving a GDMT and those with a treatment not in line with GDMT (nGDMT). RESULTS: Data from 56,671 patients with previous MI and 96,257 patients with previous stroke/TIA were included; 50.1% of MI patients and 28.5% of stroke/TIA patients received a GDMT. Fewer major CV events (MACE), defined as death or recurrent stroke, TIA, or MI, occurred in patients who received a GDMT that was started at least 30 days after the first event, compared to those who did not receive such a treatment (both groups p < 0.001). CONCLUSIONS: GDMT concerning secondary CV prevention is poorly implemented in daily medical practice, resulting in a higher CV event rate for those who do not receive such a recommended treatment. From a clinical, patient and health-economic perspective, all relevant parties should improve guideline implementation in clinical practice.