Aspirin for Secondary Prevention after Acute Myocardial Infarction in the Elderly: Prescribed Use and Outcomes

Krumholz, Harlan M.; Radford, Martha J.; Ellerbeck, Edward F.; Hennen, John; Meehan, Thomas P.; Petrillo, Marcia K.; Wang, Yun; Jencks, Stephen F.

doi:10.7326/0003-4819-124-3-199602010-00002

Cited by 183 publications

(96 citation statements)

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“…5,6 The use of research evidence for clinical guidelines does not necessarily result in a change in clinical practice. 7,8 Many patients who could benefit from antiplatelet, 9 anticoagulant, 10 or antihypertensive 11,12 medication do not receive it. Although stroke patients are at a high risk of further vascular events 13 and may benefit from secondary prevention, population-based data on their vascular risk management is limited, and most of the available studies comprise hospital-based cohorts.…”

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confidence: 99%

Antithrombotic and Antihypertensive Management 3 Months After Ischemic Stroke

Hillen

Dundas

Lawrence

et al. 2000

Stroke

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Background and Purpose-We sought to examine the frequency, predictors, and effects of nontreatment with antithrombotic and antihypertensive therapies 3 months after ischemic stroke. Methods-The population-based South London Community Stroke Register prospectively collected data on first-in-alifetime strokes between 1995 and 1997. Among patients registered with ischemic stroke, treatment status with antithrombotic and antihypertensive therapies was examined 3 months after the event. Results-In a cohort of 457 patients with ischemic stroke, 393 (86.0%) were considered appropriate for antiplatelet medication, 32 (7.0%) for anticoagulant medication, and 254 (55.9%) for antihypertensive medication. The rates of nontreatment observed 3 months after the event were 24.4% for antiplatelet, 59.4% for anticoagulant, and 29.5% for antihypertensive medication. Independent risk factors for nontreatment with antithrombotic therapies (antiplatelets and anticoagulants) were the subtype of stroke (nonlacunar infarct: ORϭ1.60, 95% CI 1.07 to 2.54), stroke severity measured by the Glasgow Coma Scale (GCS) score (GCS Յ13: OR 2.08, 95% CI 1.18 to 3.66) and the Barthel Index (BI) score 5 days after the event (BI Յ10: OR 1.85, 95% CI 1.17 to 2.93). For antihypertensive therapies the stroke subtype (OR 2.46, 95% CI 1.33 to 4.54), GCS score (OR 2.97, 95% CI 1.35 to 6.53), BI score (OR 2.33, 95% CI 1.27 to 4.29), and ethnicity (Caucasian: OR 2.43, 95% CI 1.15 to 5.14) were independently associated with nontreatment. Cox regression modeling showed no significant association between the treatment status and recurrence-free 3-year survival rates after controlling for severity and subtype of stroke. Conclusions-Secondary prevention for a common disease such as stroke appears to be inadequate in the study area.Healthcare professionals need to consider antithrombotic and antihypertensive therapies for all stroke patients. (Stroke. 2000;31:469-475.)

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confidence: 99%

Antithrombotic and Antihypertensive Management 3 Months After Ischemic Stroke

Hillen

Dundas

Lawrence

et al. 2000

Stroke

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“…We considered the rate of use of acetylsalicylic acid in our study to be adequate, because, despite the recommendation for this drug to be routinely used in acute myocardial infarction due to its effect on mortality reduction at a low cost and good tolerability, some studies still show its lower use in elderly patients. In a recent analysis of 5,490 patients above 65 years of age hospitalized with acute myocardial infarction, only 76% of the patients with no contraindications received acetylsalicylic acid during hospitalization 47 . …”

Section: Discussionmentioning

confidence: 99%

“…In the elderly, a trend in a reduced use of drugs like beta-blockers, acetylsalicylic acid, and thrombolytic agents with proved efficacy in treating myocardial infarction has been shown in several studies that assessed the use of these medications in clinical practice [16][17][18][19][20][21] .…”

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confidence: 99%

Pharmacological Therapy for Myocardial Infarction in the Elderly: An 8-year Analysis

Makdisse¹,

Matsushita²,

Júnior³

et al. 2002

Arq. Bras. Cardiol.

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“…44 Omission errors in acute cardiac care are represented most dramatically by the relatively low rates of aspirin administration in the first 24 hours of MI. This omission occurs despite the fact that aspirin reduces mortality and reinfarction, [45][46][47] particularly when given in combination with fibrinolytic therapy. 48 However, in the first National Registry of Myocardial Infarction (NRMI), involving 240 989 patients, only 87% of thrombolytic-treated patients received aspirin.…”

Section: Errors Of Omissionmentioning

confidence: 99%