title: Secondary prevention after acute myocardial infarction: drug adherence, treatment goals, and predictors of health lifestyle habits. The BLITZ-4 Registry.
abstract: BACKGROUND
  To describe drug adherence and treatment goals, and to identify the independent predictors of smoking persistence and unsatisfactory lifestyle habits six months after an acute myocardial infarction (AMI).
  
  
  RESULTS
  11,706 patients with AMI (30% female, mean age 68 years) were enrolled in 163 large-volume coronary care units (CCUs). At six months, drug adherence was ≥90%, while blood pressure (BP) <140/90 mmHg, low density lipoprotein (LDL) <100 mg/dl (in patients on statins), HbA1c <7% (in treated diabetics), and smoking persistence were observed in 74%, 76%, 45%, and 27% of patients, respectively. Inadequate fish intake decreased from 73% to 55%, inadequate intake of fruit and vegetables from 32% to 23%, and insufficient exercise in eligible patients from 74% to 59% (p < 0.0001). At multivariable analysis, a post-discharge cardiac visit and referral to cardiac rehabilitation at follow-up were independently associated with a lower risk of insufficient physical exercise (odds ratio (OR) 0.71 and 0.70, respectively) and persistent smoking (OR 0.68 and 0.60), whereas only referral to cardiac rehabilitation was associated with a lower risk of inadequate fish and fruit/vegetable intake (OR 0.70 and 0.65).
  
  
  CONCLUSIONS
  Six months after an AMI, despite a high adherence to drug treatments, BP, LDL, and diabetic goals are inadequately achieved. Subjects with healthy lifestyles improved after discharge, but the rate of those with regular exercise habits and adequate fish intake could be further improved. Access to post-discharge cardiac visit and referral to cardiac rehabilitation were associated with better adherence to healthy lifestyles. Knowledge of the variables associated with specific lifestyle changes may help in tailoring secondary prevention programmes.
authors.affiliation: Ospedale Bellaria, Department of Cardiology, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Urbinati
authors.affiliation: Ospedale Ca' Foncello, Department of Cardiology, Treviso, Italy.
authors.forename: Zoran
authors.initials: Z
authors.lastname: Olivari
authors.affiliation: ANMCO Research Center, Florence, Italy.
authors.forename: Lucio
authors.initials: L
authors.lastname: Gonzini
authors.affiliation: Ospedale Alessandro Manzoni, Department of Cardiology, Lecco, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Savonitto
authors.affiliation: A.O.U. S. Giovanni di Dio - Ruggi D'Aragona, UOC UTIC, Salerno, Italy.
authors.forename: Rosario
authors.initials: R
authors.lastname: Farina
authors.affiliation: Azienda Ospedaliera di Perugia, Department of Cardiology, Perugia, Italy.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Del Pinto
authors.affiliation: IRCCS Az Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Department of Cardiology, Genova, Italy.
authors.forename: Alberto
authors.initials: A
authors.lastname: Valbusa
authors.affiliation: Azienda Ospedaliero-Universitaria Policlinico, Department for the Treatment of Cardiovascular Diseases, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Fantini
authors.affiliation: Ospedale Campo di Marte, Department of Cardiology, Lucca, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Mazzoni
authors.affiliation: ANMCO Research Center, Florence, Italy centrostudi@anmco.it.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D004032:Diet / Q000009:adverse effects; D015444:Exercise; D005260:Female; D006184:Habits; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007558:Italy; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000379:methods*; D012907:Smoking / Q000009:adverse effects; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents
keywords: Acute myocardial infarction; cardiac rehabilitation; drug adherence; lifestyle; physical exercise; secondary prevention