Key result
Guideline-directed medical therapy after AMI rose to ~58% in 2005, more than doubling from 2000.
Why the study?
Current practice guidelines recommend routine use of several effective cardiac medications in hospital survivors of AMI, but trends in their combined use over time across multiple countries were unclear.
Observational (n=26,413)
Yes
Absolute Event Rate: 58% vs 23%
Substantial gains in post-MI quadruple therapy warrant ongoing audits; extends temporal trends but leaves open outcome links and contemporary relevance.
BACKGROUND: Current practice guidelines recommend the routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI). METHODS: We explored a recent 5-year (2000-2005) trend in hospital use of aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, and combinations thereof, in 26 413 adult men and women without contraindications to any of these therapies discharged after AMI from hospitals located in 14 countries that were included in the Global Registry of Acute Coronary Events. RESULTS: Relatively steady increases in the use of ACE inhibitors, beta-blockers, and statin therapy were observed over time, with particularly marked increases in the use of lipid-lowering therapy (from 45% in 2000 to 85% in 2005). Aspirin use remained high (by approximately 95% of patients after AMI) during all periods examined. The percentage of hospital survivors treated with all 4 cardiac medications increased from 23% in 2000 to 58% during 2005. Advancing age (>/= 65 years), female sex, medical history of heart failure or stroke, and development of atrial fibrillation during hospitalization were associated with underuse of combination medical therapy. Relatively similar factors were associated with the underuse of combination medical therapy in patients with ST-segment elevation AMI and non-ST-segment elevation AMI. CONCLUSIONS: Our results suggest encouraging increases over time in the use of combination medical therapy in patients hospitalized with AMI without contraindications to these medications. Educational efforts designed to increase the use of these therapies, as well as efforts to simplify medication regimens and enhance rates of adherence, remain warranted.
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Robert Joel Goldberg (2007) conducted an observational in Acute Myocardial Infarction (n=26,413). Time period (2005) vs. Time period (2000) was evaluated on Use of all 4 cardiac medications (aspirin, beta-blockers, ACE inhibitors, lipid-lowering agents). The percentage of hospital survivors of acute myocardial infarction treated with all four guideline-recommended cardiac medications increased from 23% in 2000 to 58% in 2005.