title: Time trends and gender differences in prevention guideline adherence and outcome after myocardial infarction: Data from the SWEDEHEART registry.
abstract: BACKGROUND
  While secondary prevention improves prognosis after acute myocardial infarction (AMI), previous studies have suggested suboptimal guideline adherence, lack of improvement over time and gender differences. This study contributes contemporary data from a large national cohort.
  
  
  METHODS
  We identified 51,620 patients <75 years examined at two and/or twelve months post AMI in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Risk factor control and readmissions at one year were compared between the 2005 and 2012 cohorts, and between genders.
  
  
  RESULTS
  Lipid control (LDL-cholesterol <2.5 mmol/L) improved from 67.9% to 71.1% (p = 0.016) over time, achieved by 67.9% vs 63.3%, p < 0.001 of men vs women. Blood pressure control (<140 mmHg systolic) increased over time (59.1% vs 69.5%, p < 0.001 in 2005 and 2012 cohorts) and was better in men (66.4% vs 61.9%, p < 0.001). Smoking cessation rate was 55.6% without differences between genders or over time. Cardiac readmissions occurred in 18.2% of women and 15.5% of men, decreasing from 2005 to 2012 (20.8% vs 14.9%). Adjusted odds ratio was 1.22 (95% CI 1.14-1.32) for women vs men and 0.94 (95% CI 0.92-0.96) for the 2012 vs the 2005 cohort.
  
  
  CONCLUSIONS
  Although this study compares favourably to previous studies of risk factor control post AMI, improvement over time was mainly seen regarding blood pressure, revealing substantial remaining preventive potential. The reasons for gender differences seen in risk factor control and readmissions require further analysis.
authors.affiliation: Department of Cardiology, Falun Hospital, Sweden Department of Medical Sciences, Uppsala University, Sweden Kristina.hambraeus@ltdalarna.se.
authors.forename: Kristina
authors.initials: K
authors.lastname: Hambraeus
authors.affiliation: Department of Cardiology, Skane University Hospital, Sweden.
authors.forename: Patrik
authors.initials: P
authors.lastname: Tydén
authors.affiliation: Department of Medical Sciences, Uppsala University, Sweden Uppsala Clinical Research Centre, Sweden.
authors.forename: Bertil
authors.initials: B
authors.lastname: Lindahl
mesh_terms: D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D019983:Guideline Adherence; D015438:Health Behavior; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000517:prevention & control*; D010359:Patient Readmission / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D012042:Registries; D055502:Secondary Prevention; D017678:Sex Distribution; D012737:Sex Factors; D016540:Smoking Cessation / Q000706:statistics & numerical data; D013548:Sweden / Q000453:epidemiology; D016903:Drug Monitoring
chemical_list: D002317:Cardiovascular Agents; D008078:Cholesterol, LDL
keywords: Guideline adherence; Secondary prevention; myocardial infarction; registry study