title: Trends in the incidence and management of acute myocardial infarction from 1999 to 2008: get with the guidelines performance measures in Taiwan.
abstract: BACKGROUND
  The American Heart Association Get With the Guidelines (GWTG) program has improved care quality of acute myocardial infarction (AMI) with important implications for other countries in the world. This study evaluated the incidence and care of AMI in Taiwan and assessed the compliance of GWTG in Taiwan.
  
  
  RESULTS
  We used the Taiwan National Health Insurance Research Database (1999-2008) to identify hospitalized patients ≥18 years of age presenting with AMI. The temporal trends of annual incidence and care quality of AMI were evaluated. The age-adjusted incidence of AMI (/100 000 person-years) increased from 28.0 in 1999 to 44.4 in 2008 (P<0.001). The use of guideline-based medications for AMI was evaluated. The use of dual antiplatelet therapy (DAPT) increased from 65% in 2004 to 83.9% in 2008 (P<0.001). Angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) was used in 72.6% in 2004 and 71.7% in 2008 (P=NS) and β-blocker was used in 60% in 2004 and 59.7% in 2008 (P=NS). Statin use increased from 32.1% to 50.1% from 2004 to 2008 (P<0.001). The in-hospital mortality decreased from 15.9% in 1999 to 12.3% in 2008 (P<0.0001). Multivariable analysis showed that DAPT, ACE inhibitor/ARB, β-blocker, and statin use during hospitalization were all associated with reduced in-hospital mortality in our AMI patients.
  
  
  CONCLUSIONS
  AMI incidence was increasing, but the guideline-based medications for AMI were underutilized in Taiwan. Quality improvement programs, such as GWTG, should be promoted to improve AMI care and outcomes in Taiwan.
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Cheng-Han
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.L.C., Y.H.K.Y.).
authors.forename: Ching-Lan
authors.initials: CL
authors.lastname: Cheng
authors.affiliation: Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.L.C., Y.H.K.Y.).
authors.forename: Yea-Huei Kao
authors.initials: YH
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Ting-Hsing
authors.initials: TH
authors.lastname: Chao
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Ju-Yi
authors.initials: JY
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Ping-Yen
authors.initials: PY
authors.lastname: Liu
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Chih-Chan
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Shih-Hung
authors.initials: SH
authors.lastname: Chan
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Liang-Miin
authors.initials: LM
authors.lastname: Tsai
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Jyh-Hong
authors.initials: JH
authors.lastname: Chen
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Li-Jen
authors.initials: LJ
authors.lastname: Lin
authors.affiliation: Department of Internal Medicine, College of Medicine and Hospital, National Cheng Kung University, Tainan, Taiwan (C.H.L., T.H.C., J.Y.C., P.Y.L., C.C.L., S.H.C., L.M.T., J.H.C., L.J.L., Y.H.L.).
authors.forename: Yi-Heng
authors.initials: YH
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography / Q000639:trends*; D001026:Coronary Artery Bypass / Q000639:trends; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D009204:Myocardial Revascularization / Q000639:trends*; D062645:Percutaneous Coronary Intervention / Q000639:trends; D017410:Practice Guidelines as Topic; D013624:Taiwan / Q000453:epidemiology; D061665:Time-to-Treatment / Q000639:trends
keywords: epidemiology; incidence; myocardial infarction; population
references.citation: Int J Cardiol. 2007 Sep 14;121(1):127-9
references.pmid: 17107726
references.citation: Circ Cardiovasc Qual Outcomes. 2011 Sep;4(5):557-64
references.pmid: 21862718
references.citation: Circ Cardiovasc Qual Outcomes. 2012 Jan;5(1):126-33
references.pmid: 22235068
references.citation: Circulation. 2008 Dec 16;118(25):2702-9
references.pmid: 19106393
references.citation: Circulation. 2008 Feb 5;117(5):598-604
references.pmid: 18212284
references.citation: N Engl J Med. 2010 Jun 10;362(23):2155-65
references.pmid: 20558366
references.citation: Circulation. 2013 Jan 29;127(4):529-55
references.pmid: 23247303
references.citation: BMC Public Health. 2013 Apr 09;13:318
references.pmid: 23570503
references.citation: Circ Cardiovasc Qual Outcomes. 2012 Sep 1;5(5):654-61
references.pmid: 22949493
references.citation: J Hypertens. 2008 Mar;26(3):600-6
references.pmid: 18300873
references.citation: Circulation. 2013 Jun 11;127(23):e663-828
references.pmid: 23630129
references.citation: Health Aff (Millwood). 2003 May-Jun;22(3):77-88
references.pmid: 12757274
references.citation: Circ J. 2013;77(11):2841-3
references.pmid: 24067325
references.citation: Ageing Res Rev. 2010 Nov;9 Suppl 1:S23-7
references.pmid: 20673815
references.citation: Am Heart J. 2006 Jan;151(1):206-12
references.pmid: 16368320
references.citation: Circulation. 2011 Jan 4;123(1):46-52
references.pmid: 21173352
references.citation: Int J Cardiol. 2013 Sep 30;168(2):993-8
references.pmid: 23168007
references.citation: Am Heart J. 2008 Dec;156(6):1045-55
references.pmid: 19032998
references.citation: Am Heart J. 2010 Jun;159(6):1012-9
references.pmid: 20569714
references.citation: BMC Health Serv Res. 2010 Aug 04;10:225
references.pmid: 20682077
references.citation: Am J Med. 2010 Mar;123(3):259-66
references.pmid: 20193835
references.citation: Circ J. 2013;77(4):934-43
references.pmid: 23502993
references.citation: Circ J. 2010 Jan;74(1):93-100
references.pmid: 19942783