Initiation of and long-term adherence to secondary preventive drugs after acute myocardial infarction

Abstract

BackgroundSecondary preventive drug therapy following acute myocardial infarction (AMI) is recommended to reduce the risk of new cardiovascular events. The aim of this nationwide cohort study was to examine the initiation and long-term use of secondary preventive drugs after AMI.MethodsThe prescription of drugs in 42,707 patients < 85 years discharged alive from hospital after AMI in 2009–2013 was retrieved by linkage of the Norwegian Patient Register, the Norwegian Prescription Database, and the Norwegian Cause of Death Registry. Patients were followed for up to 24 months.ResultsThe majority of patients were discharged on single or dual antiplatelet therapy (91 %), statins (90 %), beta-blockers (82 %), and angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor II blockers (ARB) (60 %). Patients not undergoing percutaneous coronary intervention (PCI) (42 %) were less likely to be prescribed secondary preventive drugs compared with patients undergoing PCI. This was particular the case for dual antiplatelet therapy (43 % vs. 87 %). The adherence to prescribed drugs was high: 12 months after index AMI, 84 % of patients were still on aspirin, 84 % on statins, 77 % on beta-blockers and 57 % on ACEI/ARB. Few drug and dose adjustments were made during follow-up.ConclusionGuideline-recommended secondary preventive drugs were prescribed to most patients discharged from hospital after AMI, but the percentage receiving such therapy was significantly lower in non-PCI patients. The long-time adherence was high, but few drug adjustments were performed during follow-up. More attention is needed to secondary preventive drug therapy in AMI patients not undergoing PCI.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0283-6) contains supplementary material, which is available to authorized users.

Implications of the PEGASUS-TIMI 54 trial for US clinical practice

“…This gap in care delivery is consistent with prior studies19–21 and suggests an opportunity to improve patient outcomes through more consistent use of P2Y 12 at discharge for MI.…”

BEtablocker Treatment After acute Myocardial Infarction in revascularized patients without reduced left ventricular ejection fraction (BETAMI): Rationale and design of a prospective, randomized, open, blinded end point study

“…In a recent Norwegian nationwide study, 82% of post-MI patients received β-blockers at discharge, a figure that only decreased by 5% after 12 months follow-up. 22 Similar estimates are reported internationally, but with large variations between countries. 23 Whilst β-blockers are considered relatively safe and inexpensive, they do have well-known and common side effects [1][2][3] that may have deteriorating effect on quality of life, functional status, and health economic aspects such as the ability to work and health-care utilization.…”

“…[1][2][3] In Norwegian revascularized post-MI patients without heart failure, the prescribed dosages equipotent to metoprolol succinate over the first 12 months ranged 25-100 mg (mean 60mg) daily. 22 Treatment with suboptimal β-blocker doses could therefore potentially partly explain why the beneficial effects of β-blocker are not reproduced in observational studies conducted in the post-revascularization period. [12][13][14][15]16 The impact of β-blocker doses on cardiac outcomes has recently been addressed in several observational studies.…”

Clinical factors associated with initiation of and persistence with ADP receptor-inhibiting oral antiplatelet treatment after acute coronary syndrome: a nationwide cohort study from Finland

“…In comparison to results from Sweden, Norway and Denmark, in which about 70% of the patients received OAP treatment after myocardial infarction, OAP use in this study was low. [21][22][23] Our study, however, also included patients with unstable angina pectoris who were less likely to receive an OAP than patients with myocardial infarction.…”