title: Use of combination evidence-based medical therapy prior to acute myocardial infarction (from the National Registry of Myocardial Infarction-4).
abstract: Utilization rates of aspirin, beta blockers, angiotensin-converting enzyme inhibitors, and statins singly and as part of a multidrug regimen before hospitalization were measured in 109,540 patients with a history of coronary artery disease presenting with acute myocardial infarction to 1,283 hospitals participating in the National Registry of Myocardial Infarction-4. The profile of patients receiving none or only 1 of these therapies was compared with that of patients receiving any 3 or all 4 agents. Most patients (58%) with a history of coronary artery disease presenting with acute myocardial infarction were on none or only 1 of these effective medications at hospital admission. Only 21% of patients were on >or=3 of these therapies. Older age, female gender, and Medicare or no insurance coverage was significantly associated with previous receipt of <or=1 agent. Patients from New England or with a history of diabetes mellitus, hypertension, or hyperlipidemia were more likely to have received >or=3 of these therapies. In conclusion, data from this large national registry have indicated that most patients with a history of CAD were not receiving the recommended combination of cardiac medications before their AMI.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA. spencerf@ummhc.org
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Paul D
authors.initials: PD
authors.lastname: Frederick
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Tiefenbrunn
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000008:administration & dosage; D001241:Aspirin / Q000008:administration & dosage; D003324:Coronary Artery Disease / Q000150:complications / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control*
chemical_list: D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D001241:Aspirin