title: Discontinuation of secondary prevention medication after myocardial infarction - the role of general practitioners and patients.
abstract: BACKGROUND
  Despite the significant benefits of secondary prevention (SP) medication after acute myocardial infarction (MI), evidence suggests that these medications are neither consistently prescribed nor appropriately adhered to by patients. The aim of this study was to investigate the role of general practitioners (GPs) and patients regarding discontinuation of SP medication after MI and reasons for discontinuation.
  
  
  METHODS
  In this observational study, GPs of patients who had suffered acute MI provided information on discontinuation of SP medication 6 and 12 months after hospital discharge. A questionnaire-based approach was used (a) to assess the consistent use of SP medication after MI, (b) to determine reasons for stopping SP medication, (c) to quantify the involvement of GPs and patients regarding discontinuation, and (d) to analyse potential factors that are associated with discontinuation of medication.
  
  
  RESULTS
  Of 204 subjects 6 and 12 months after hospital discharge 83% and 75% patients, respectively, were still on recommended SP medication. Overall, one or more SP medications were stopped (53 medications) or modified (15 medications) in 52 (25%) patients. Adverse side effects were the main reason for stopping medication (63%). GPs reported being responsible for initiating discontinuation or modification more frequently than patients (62% vs 38%, p = 0.065).
  
  
  CONCLUSIONS
  The consistent use of evidence-based pharmacotherapy 6 and 12 months after myocardial infarction was adequate. Three out of four patients were still on recommended SP medication after 1 year of follow-up. Two-thirds of medication discontinuations were initiated by GPs, predominantly because of side effects.
authors.affiliation: Institute of Primary Care, Basel, SWITZERLAND; klaus.bally@unibas.ch.
authors.forename: Klaus
authors.initials: K
authors.lastname: Bally
authors.forename: Ronny R
authors.initials: RR
authors.lastname: Buechel
authors.forename: Peter
authors.initials: P
authors.lastname: Buser
authors.forename: Peter
authors.initials: P
authors.lastname: Tschudia
authors.forename: Benedict
authors.initials: B
authors.lastname: Martinaa
authors.forename: Andreas
authors.initials: A
authors.lastname: Zeller
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists / Q000627:therapeutic use*; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D005260:Female; D058006:General Practice / Q000379:methods / Q000706:statistics & numerical data*; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D055502:Secondary Prevention / Q000379:methods / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016903:Drug Monitoring
chemical_list: D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin