Abstract 15550: Utilization of Guideline-Concordant Therapies in Longitudinal Care After Myocardial Infarction as a Function of Patient Risk
Background: Prior studies have revealed that high-risk acute myocardial infarction (AMI) patients are less likely to receive guideline-concordant therapies during hospitalization. We assessed if such risk-treatment paradox persists following discharge.
Methods: Data was analyzed from combined PREMIER and TRIUMPH registries: prospective, 31-center U.S. studies of AMI outcomes from 2003-2008. We included 6,434 AMI patients discharged home, classified into low, moderate or high-risk categories based on GRACE risk score at discharge (see Figure). Medication persistence was defined as continued use of medication initiated at discharge and assessed through interviews at 1, 6 and 12 months post-discharge. Hierarchical Modified Poisson models were used to assess adjusted association between persistence to each medication and risk-category.
Results: There were 2824 (43.9%), 2014 (31.3%), and 1596 (24.8%) patients in the low, moderate and high-risk categories respectively. After multivariable adjustment, high-risk patients were less likely to receive all guideline-concordant therapies at discharge (composite of aspirin, beta-blocker, statin, ACE inhibitor and smoking cessation counseling amongst eligible patients). During follow-up, compared to low-risk patients, high-risk patients were less likely to be persistently on aspirin, beta-blocker, statin and ACE inhibitor post-discharge therapies after accounting for patient differences and discharge therapies (Figure).
Conclusion: Risk-treatment paradox persists well beyond discharge following AMI. Improved efforts are needed to bolster medication persistence post discharge in high-risk patients.
- © 2013 by American Heart Association, Inc.