Combined secondary prevention after hospitalization for myocardial infarction in France: analysis from a large administrative database.
BACKGROUND
Both French and international guidelines recommend long-term use of betablockers, antiplatelet drugs, statins, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers (ACE-I/ARB) after a myocardial infarction (MI), but data on their combined use are scarce in France.


OBJECTIVE
To evaluate the use of combined medication 6 months after hospital admission for MI and the factors that can significantly influence their use.


METHODS
All hospital admissions for MI in France from January to June 2006 were selected from the national hospital discharge database. Data on medications used 6 months before and after hospitalization for patients covered by the general health insurance scheme (70% of French population) were collected from the reimbursement information system. A medication was considered to be used when there were more than three reimbursement applications over the 6 months following the index episode. Comorbidities were ascertained from the use of disease-specific medication reimbursements and registration in the national database of full coverage for 30 long-term disorders.


RESULTS
Of the 11,671 patients included, 82% were reimbursed for betablockers, 92% for antiplatelets, 85% for statins, 80% for ACE-I/ARBs and 62% for all four classes. After adjustment, significant underuse was found for women, the elderly and those with several comorbidities. Treatment at a university hospital or high-volume centre, follow-up by a cardiologist and use of revascularization procedures were associated with improved rates of combination therapy use.


CONCLUSIONS
Overall, use of recommended medications after MI in France is satisfactory, though not optimal. Specific recommendations focusing on subgroups such as older patients or those with comorbidities, as well as information directed towards non-specialized healthcare professionals, should help to improve appropriate use of these medications.
Tuppin
Philippe
P
Département des études sur les pathologies et les patients, direction de la stratégie des études et des statistiques, Caisse nationale d'assurance maladie des travailleurs salariés, Paris, France. philippe.tuppin@cnamts.fr
Neumann
Anke
A
Danchin
Nicolas
N
Weill
Alain
A
Ricordeau
Philippe
P
de Peretti
Christine
C
Allemand
Hubert
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015897:Comorbidity; D019992:Databases as Topic; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D004359:Drug Therapy, Combination; D005260:Female; D005602:France / Q000453:epidemiology; D019983:Guideline Adherence; D019538:Health Care Surveys; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007349:Insurance, Health, Reimbursement / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D009313:National Health Programs / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D055502:Secondary Prevention; D013997:Time Factors
D002317:Cardiovascular Agents