title: Combination evidence-based therapy is effective in the oldest 'old patients' following myocardial infarction. The "Salute e Benessere nell'Anziano" (SeBA) observational study.
abstract: Antiplatelet drugs, statins, angiotensinogen-converting enzyme inhibitors or angiotensin-II receptor blockers, and β-blockers improve survival following myocardial infarction (MI). However, in old age they are under-prescribed, and their effectiveness in combination regimens is unproven. The aim of the study was to evaluate prescription of recommended cardiovascular drug classes and impact of a combination regimen on long-term mortality and hospitalizations. Records of 65+ years MI survivors, discharged from hospitals in four Local Health Units in Italy, were selected from administrative databases and analyzed. All-cause mortality and cardiovascular re-hospitalization in 12 months were compared across participants prescribed 0, 1, 2, 3, or 4 recommended drug classes. Out of 2626 participants (56 % men, 25 % aged 85+ years), 42 % were prescribed all, 14 % none of the recommended drug classes. The prescription rate decreased with advancing age. At all ages, mortality decreased with increasing number of drug classes prescribed: in participants aged 85+ years, adjusted hazard ratios (95 % confidence interval) for death were 0.74 (0.47-1.17), 0.52 (0.33-0.82), 0.30 (1.19-0.48), and 0.33 (0.20-0.53) for 1, 2, 3, and 4 classes prescribed, compared with none. The risk of cardiovascular re-hospitalizations decreased with an increasing number of drug classes prescribed through the age of 84 years. After MI, a combination regimen of recommended drug classes prevents long-term mortality at any age, and cardiovascular re-hospitalizations through the age of 84. Enhancing compliance with treatment guidelines may reduce the burden of mortality and hospitalizations in older MI survivors.
authors: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 18, 50139, Florence, Italy. mauro.dibari@unifi.it.|Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy. mauro.dibari@unifi.it.
authors: Mauro
authors: M
authors: Di Bari
authors: CliCon srl Health, Economics and Outcomes Research, Ravenna, Italy.
authors: Luca
authors: L
authors: Degli Esposti
authors: CliCon srl Health, Economics and Outcomes Research, Ravenna, Italy.
authors: Chiara
authors: C
authors: Veronesi
authors: Italian Medicines Agency, Rome, Italy.
authors: Sergio
authors: S
authors: Pecorelli
authors: IRCCS San Raffaele, Rome, Italy.
authors: Massimo
authors: M
authors: Fini
authors: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 18, 50139, Florence, Italy.|Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Samuele
authors: S
authors: Baldasseroni
authors: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 18, 50139, Florence, Italy.|Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Enrico
authors: E
authors: Mossello
authors: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 18, 50139, Florence, Italy.|Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Stefano
authors: S
authors: Fumagalli
authors: Sanofi Aventis Foundation, Milan, Italy.
authors: Marco
authors: M
authors: Scatigna
authors: Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 18, 50139, Florence, Italy.|Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy.
authors: Niccolò
authors: N
authors: Marchionni
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000494:pharmacology / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057912:Angiotensin II Type 2 Receptor Blockers / Q000494:pharmacology / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D015331:Cohort Studies; D019317:Evidence-Based Medicine / Q000379:methods* / Q000592:standards; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D063868:Patient Outcome Assessment; D010975:Platelet Aggregation Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D012044:Regression Analysis
chemical_list: D000319:Adrenergic beta-Antagonists; D057912:Angiotensin II Type 2 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors
keywords: Administrative databases; Coronary artery disease; Drug treatment; Elderly