title: Trends in the use of guideline-recommended medications and in-hospital mortality of patients with acute myocardial infarction in a Chinese population.
abstract: OBJECTIVE
  Current practice guidelines recommend the routine use of several cardiac medications early in the course of acute myocardial infarction (AMI). Our objective was to analyze temporal trends in medication use and in-hospital mortality of AMI patients in a Chinese population.
  
  
  METHODS
  This is a retrospective observational study using electronic medical records from the hospital information system (HIS) of 14 Chinese hospitals. We identified 5599 patients with AMI between 2005 and 2011. Factors associated with medication use and in-hospital mortality were explored by using hierarchical logistic regression.
  
  
  RESULTS
  The use of several guideline-recommended medications all increased during the study period: statins (57.7%-90.1%), clopidogrel (61.8%-92.3%), β-Blockers (45.4%-65.1%), ACEI/ARB (46.7%-58.7%), aspirin (81.9%-92.9%), and the combinations thereof increased from 24.9% to 42.8% (P<0.001 for all). Multivariate analyses showed statistically significant increases in all these medications. The in-hospital mortality decreased from 15.9% to 5.7% from 2005 to 2011 (P<0.001). After multivariate adjustment, admission year was still a significant factor (OR = 0.87, 95% CI 0.79-0.96, P = 0.007), the use of aspirin (OR = 0.64, 95% CI 0.46-0.87), clopidogrel (OR = 0.44, 95% CI 0.31-0.61), ACEI/ARB (OR = 0.73, 95% CI 0.56-0.94) and statins (OR = 0.54, 95% CI 0.40-0.73) were associated with a decrease in in-hospital mortality. Patients with older age, cancer and renal insufficiency had higher in-hospital mortality, while they were generally less likely to receive all these medications.
  
  
  CONCLUSIONS
  Use of guideline-recommended medications early in the course of AMI increased between 2005 and 2011 in a Chinese population. During this same time, there was a decrease in in-hospital mortality.
authors.affiliation: Evidence-based Medicine Center, School of Public Health, Peking University, Beijing, 100191, China; Beijing Traditional Chinese Medicine Hospital, Capital Medical University, Beijing, Institute of Traditional Chinese Medicine, Beijing, 100010, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Hu
authors.affiliation: Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
authors.forename: Yanming
authors.initials: Y
authors.lastname: Xie
authors.affiliation: Center for Health Economics and Epidemiology Assessment, STATinMED (Beijing) International Healthcare Technology Assessment Co., LTD, Beijing, 100025, China.
authors.forename: Zheng
authors.initials: Z
authors.lastname: Shu
authors.affiliation: Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, Beijing, 100700, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Yang
authors.affiliation: Evidence-based Medicine Center, School of Public Health, Peking University, Beijing, 100191, China; Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Centre, Beijing, 100191, China.
authors.forename: Siyan
authors.initials: S
authors.lastname: Zhan
mesh_terms: D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000401:mortality; D017410:Practice Guidelines as Topic