Increasing use of single and combination medical therapy in patients hospitalized for acute myocardial infarction in the 21st century: a multinational perspective.
BACKGROUND
Current practice guidelines recommend the routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI).


METHODS
We explored a recent 5-year (2000-2005) trend in hospital use of aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, and combinations thereof, in 26 413 adult men and women without contraindications to any of these therapies discharged after AMI from hospitals located in 14 countries that were included in the Global Registry of Acute Coronary Events.


RESULTS
Relatively steady increases in the use of ACE inhibitors, beta-blockers, and statin therapy were observed over time, with particularly marked increases in the use of lipid-lowering therapy (from 45% in 2000 to 85% in 2005). Aspirin use remained high (by approximately 95% of patients after AMI) during all periods examined. The percentage of hospital survivors treated with all 4 cardiac medications increased from 23% in 2000 to 58% during 2005. Advancing age (>/= 65 years), female sex, medical history of heart failure or stroke, and development of atrial fibrillation during hospitalization were associated with underuse of combination medical therapy. Relatively similar factors were associated with the underuse of combination medical therapy in patients with ST-segment elevation AMI and non-ST-segment elevation AMI.


CONCLUSIONS
Our results suggest encouraging increases over time in the use of combination medical therapy in patients hospitalized with AMI without contraindications to these medications. Educational efforts designed to increase the use of these therapies, as well as efforts to simplify medication regimens and enhance rates of adherence, remain warranted.
Goldberg
Robert J
RJ
Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, 55 Lake Ave, Worcester, MA 01655, USA. goldberr@ummhc.org
Spencer
Frederick A
FA
Steg
Philippe Gabriel
PG
Flather
Marcus
M
Montalescot
Gilles
G
Gurfinkel
Enrique P
EP
Kennelly
Brian M
BM
Goodman
Shaun G
SG
Dedrick
Rebecca
R
Gore
Joel M
JM
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D004346:Drug Information Services / Q000706:statistics & numerical data; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D017723:Drug Utilization Review / Q000639:trends*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D014943:Global Health; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D012189:Retrospective Studies
D000806:Angiotensin-Converting Enzyme Inhibitors; D005343:Fibrinolytic Agents; D000960:Hypolipidemic Agents