Abstract 14269: Contemporary Trends of Optimal Evidence-Based Medical Therapy at Discharge for Patients Surviving Acute Myocardial Infarction from Korea Acute Myocardial Infarction Registry
Background: Limited data are available for the recent 7-year (2005-2011) trend of optimal evidence-based medical therapy (OMT) at discharge after an acute myocardial infarction (AMI). The purpose of this study was to evaluate (1) the contemporary trends in the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors (ACE-I)/angiotensin II receptor blockers (ARB), lipid-lowering agents, and combinations thereof, in post-MI survivors; and (2) baseline characteristics associated with OMT at discharge.
Methods: The study subjects were 22,646 post-MI survivors without any documented contraindications to anti-platelet drugs, beta-blockers, ACE-I/ARBs or lipid-lowering agents in 6 annual periods between 2005 and 2011 from the Korea AMI Registry. The OMT was defined as the use of all 4 indicated medications.
Results: Of these patients, 11,999 (53.4%) received all 4 medications at discharge. The discharge prescription rates of anti-platelet agents, beta-blockers, ACE-I/ARBs and statins were 98.6%, 76.7%, 82.0%, and 78.6%, respectively. There were significant increases in the discharge use of all 4 indicated medications over time (13.9% relative increase); 49.8% and 56.7% of patients in KAMIR and KORMI Registries, respectively, were prescribed OMT (p <0.001). Although consistent increases in the use of each of the 4 indicated medications were observed over time, particularly marked relative increases in the use of beta-blockers (14.9% relative increase, p < 0.001) and statins (3.0% relative increase, p < 0.001) were noted. In multivariate analysis, enrollment in KORMI Registry (versus KAMIR) in addition to higher body mass index, prior history of dyslipidemia and hypertension, presence of ST elevation, and percutaneous coronary intervention during hospitalization were independently associated with the use of optimal medical therapy.
Conclusions: There were considerable improvements in the use of all 4 indicated medications over time. However, the optimal medical therapy is prescribed at suboptimal rates, particularly in patients with high-risk features. Educational to improve use of these therapies could further enhance the prescription rates in post-MI patients.
- © 2012 by American Heart Association, Inc.