Decade-long changes in the use of combination evidence-based medical therapy at discharge for patients surviving acute myocardial infarction.
BACKGROUND
Current practice guidelines suggest routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI). The objectives of our population-based study were to describe decade-long trends (1990-2001) in the use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, lipid-lowering agents, and combinations thereof, in patients discharged from all metropolitan Worcester (Mass) hospitals after AMI.


METHODS
The study sample consisted of 5965 adult men and women of all ages discharged after AMI from all greater Worcester hospitals in 7 annual periods between 1990 and 2001.


RESULTS
Although consistent increases in the use of each of the effective cardiac medications examined were observed over time, particularly marked relative increases in the use of angiotensin-converting enzyme inhibitors (168% relative increase) and lipid-lowering agents (1086% relative increase) were noted. Use of combinations of effective cardiac medications also increased substantially over time. Between 1990 and 2001, the percentage of hospital survivors treated with > or =3 cardiac medications increased from 12.9% to 74.0%. Advancing age, female sex, history of angina, hypertension, or heart failure during hospitalization, presence of an initial non-Q wave MI, and development of atrial fibrillation during the index hospitalization were independently associated with underuse of combination medical therapy.


CONCLUSIONS
The present results suggest considerable improvements over the last decade in the medical management of patients hospitalized with AMI. Educational efforts, however, aimed at clinicians and designed to improve use of these therapies, as well as efforts to simplify medication regimens and enhance rates of adherence, remain warranted.
Spencer
Frederick A
FA
Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA. spencerf@ummhc.org
Lessard
Darleen
D
Yarzebski
Jorge
J
Gore
Joel M
JM
Goldberg
Robert J
RJ
D000368:Aged; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010351:Patient Discharge; D017741:Survivors; D013997:Time Factors