Elsevier

American Heart Journal

Volume 159, Issue 6, June 2010, Pages 1012-1019
American Heart Journal

Clinical Investigation
Acute Ischemic Heart Disease
Suboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: Prescription rate, predictors, and prognostic value

https://doi.org/10.1016/j.ahj.2010.03.009Get rights and content

Background

Only limited data are available for the recent trend of optimal evidence-based medical therapy at discharge after acute myocardial infarction (AMI) in Asia. We evaluated the predictors for the use of optimal evidence-based medical therapy at discharge and the association between discharge medications and 6-month mortality after AMI.

Methods

Between November 2005 and January 2008, we evaluated the discharge medications among 9,294 post-MI survivors who did not have any documented contraindications to antiplatelet drugs, β-blockers, angiotensin-converting enzyme inhibitors (ACE-Is)/angiotensin II receptor blockers (ARBs), or statins in the Korea Acute Myocardial Infarction Registry. Optimal evidence-based medical therapy was defined as the use of all 4 indicated medications.

Results

Of these patients, 4,684 (50.4%) received all 4 medications at discharge. The discharge prescription rates of antiplatelet drugs, β-blockers, ACE-Is/ARBs, and statins were 99.0%, 72.7%, 81.5%, and 77.2%, respectively. In multivariate analysis, advanced age, lower systolic blood pressure, higher Killip class at admission, left ventricular systolic dysfunction, higher blood creatinine level, lower total cholesterol levels, and coronary artery bypass grafting during hospitalization were independently associated with less use of optimal evidence-based medical therapy. In contrast, patients who underwent percutaneous coronary intervention were more likely to use optimal medications. In Cox proportional hazards model, optimal evidence-based medical therapy was an independent predictor of 6-month mortality after adjusting clinical characteristics and angiographic and procedural data.

Conclusions

The optimal evidence-based medical therapy is prescribed at suboptimal rates, particularly in patients with high-risk features. New educational strategies are needed to increase the use of these secondary preventive medical therapies.

Section snippets

Study design and patient population

KAMIR is a Korean, prospective, open, observational, multicenter online registry of AMI with support of Korean Society of Cardiology (KSC) since November 2005. The 50 participating hospitals are capable of primary PCI. Details of the KAMIR have been published.12

Between November 2005 and January 2008, 14,871 patients suspected to have AMI at admission were enrolled in the KAMIR and 11,942 patients with a final diagnosis of AMI were analyzed in this study. Of these patients, baseline clinical

Results

The baseline characteristics of the overall study patients are shown in Table I. The mean age was 63.8 ± 12.5 years old, and 6,170 patients (72.2%) were men. Of the 9,294 patients with AMI, 326 (3.5%), 4,284 (46.1%), and 4,684 (50.4%) patients were discharged on <2 drugs, 2 to 3 drugs, and all 4 indicated drugs, respectively. The discharge prescription rates of antiplatelet agents, β-receptor blockers, ACE-Is/ARBs, and statins were 99.0%, 72.7%, 81.5%, and 77.2%, respectively (Figure 1). In

Discussion

Medications such as antiplatelet drugs, β-blockers, ACE-Is/ARBs, and statins have been associated with significantly improved outcomes in patients presenting with AMI regardless of the geographic location.2, 3 In the present study, even with the evidence of benefit, the prescription rates in eligible patients varied from 99% for use of antiplatelet drugs at discharge to 73% for β-blockers at discharge in overall patients. Only half of the eligible patients received OMT at discharge. Our results

Conclusion

This study provides useful information on the pattern of discharge medication use and clinical outcome at 6 months in patients receiving OMT in Asian populations. Despite strong benefits of recommended cardiac drugs, these pharmacologic agents are prescribed at suboptimal rates, particularly in patients with high-risk features who may derive the greater therapeutic benefits. New educational strategies and initiatives are needed to increase the use of these secondary preventive medical therapies

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    A list of participating Korea Acute Myocardial Infarction Registry Investigators can be found in Am J Cardiol 2009;104:182-9.

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