Key result
Higher-dose post-MI guideline medications fail to improve LVEF recovery or reassessment rates at 6 months.
Why the study?
Achieving target doses of indicated post-MI medications improves outcomes, but whether adherence to evidence-based dosing is associated with follow-up LVEF imaging or LVEF progression was unknown.
Does taking ≥50% of the target dose of core cardiac medications improve LVEF progression or receipt of follow-up imaging in patients with acute MI and LVEF ≤ 45%?
Cohort (n=501)
Yes
Does taking ≥50% of the target dose of core cardiac medications improve LVEF progression or receipt of follow-up imaging in patients with acute MI and LVEF ≤ 45%?
Answers are grounded in this paper and cite their sources.
In patients with acute MI and reduced LVEF, achieving ≥50% of target medication doses was poor (except for statins) and was not associated with LVEF improvement at 6 months.
Background: Achieving the target doses of indicated medications after myocardial infarction (MI) is associated with improved outcomes and is a marker of the quality of care. We studied the use and follow-up dosing of core cardiac medications among patients with MI complicated by depressed left ventricular ejection fraction (LVEF). Our objective was to determine whether adherence to evidence-based medication dosing is associated with receipt of follow-up LVEF imaging or progression of LVEF within 6 months of follow-up care. Methods: The Acute Myocardial Infarction Quality Assurance (AMIQA) Canada study enrolled 501 patients (mean age 63 years; 22.6% female) with acute MI and LVEF ≤ 45%, from 14 Canadian centres. Patients were followed for 6 months to determine their adherence to post-MI follow-up recommendations. We assessed use and dosing of beta-blockers, angiotension-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and statins, and compared changes in LVEF among those taking ≥50% vs < 50% of the target dose in the follow-up period. Receiving ≥ 50% of the target dose was not associated with changes in LVEF. Conclusions: Except for statins, most patients were not receiving target doses of indicated medications after MI with reduced LVEF. Follow-up dosing was not associated with LVEF reassessment or improvement in LVEF. Future quality-improvement initiatives may require distinct strategies for improving adherence to recommendations for medication dosing vs follow-up imaging.
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Wilson et al. (2025) conducted a cohort in Acute myocardial infarction with depressed LVEF (n=501). ≥50% of the target dose of indicated cardiac medications vs. <50% of the target dose was evaluated on Changes in LVEF. Receiving ≥50% of the target dose of indicated medications after MI with reduced LVEF was not associated with LVEF reassessment or improvement at 6 months.
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