Key result
The use of optimal medical therapy at discharge for post-MI patients increased significantly from 48.6% in 2005-2006 to 63.2% in 2011 (adjusted OR 1.69; P<0.001).
Observational (n=17,578)
Yes
Despite a gradual increase in the prescription of optimal medical therapy at discharge for AMI patients over a 6-year period, a gap between guidelines and clinical practice remains, particularly among the elderly.
Increasing post-MI optimal medical therapy prescriptions supports quality monitoring; leaves open whether closing elderly gaps improves outcomes.
BACKGROUND: Temporal trends of evidence-based optimal medical therapy (OMT) at discharge after acute myocardial infarction (AMI) have not been investigated in recent years. HYPOTHESIS: OMT should have been increased in AMI and gap between guidelines and practices in its use should have been narrowed. METHODS: We examined discharge medications of 17,578 post-MI patients who had no documented contraindications to antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors, or statins across a 6-year period (divided into subperiods of November 2005 to December 2006 [period 1], 2007 [period 2], 2008 [period 3], 2009 [period 4], 2010 [period 5], and January to June 2011 [period 6]) in the Korean AMI Registry. OMT was defined as use of all 4 indicated medications. RESULTS: Marked increases in OMT (48.6% to 63.2%) were seen irrespective of age and sex, mainly attributed to marked increases in the use of β-blockers (70.3% to 83.7%) and statins (76.9% to 82.6%) from period 1 to period 6. The gap in use of OMT between men and women narrowed over time between the first and second 3 periods, but not between the young and the elderly. Advanced age (odds ratio [OR]: 0.88, P = 0.04) was independently associated with underuse of OMT. Adjusted ORs for OMT from period 1 to period 6 were as follows: 1, 1.14 (P = 0.024), 1.21 (P = 0.001), 1.40 (P < 0.001), 1.47 (P < 0.001), and 1.69 (P < 0.001), respectively. CONCLUSIONS: Despite gradual increase in OMT over time, the gap between guidelines and practices in use of OMT continues to exist.
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Lee et al. (2015) conducted an observational in acute myocardial infarction (n=17,578). Later time period (January to June 2011) vs. Earlier time period (November 2005 to December 2006) was evaluated on Use of optimal medical therapy (OMT) at discharge (OR 1.69, p=<0.001). The use of optimal medical therapy at discharge for post-MI patients increased significantly from 48.6% in 2005-2006 to 63.2% in 2011 (adjusted OR 1.69; P<0.001).
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