title: Long-term secondary prevention of acute myocardial infarction (SEPAT) - guidelines adherence and outcome.
abstract: A number of registry studies have reported suboptimal adherence to guidelines for cardiovascular prevention during the first year after acute myocardial infarction (AMI). However, only a few studies have addressed long-term secondary prevention after AMI. This study evaluates prevention guideline adherence and outcome of guideline-directed secondary prevention in patients surviving 2 years after AMI.
  
  
  
  Patients aged 18-85 years at the time of their index AMI were consecutively identified from hospital discharge records between July 2010 and December 2011 in Gothenburg, Sweden. All patients who agreed to participate in the study (16.2%) were invited for a structured interview, physical examinations and laboratory analysis 2 years after AMI. Guideline-directed secondary preventive goals were defined as optimally controlled blood pressure, serum cholesterol, glucose, regular physical activity, smoking cessation and pharmacological treatment.
  
  
  
  The mean age of the study cohort (n = 200) at the index AMI was 63.0 ± 9.7 years, 79% were men. Only 3.5% of the cohort achieved all six guideline-directed secondary preventive goals 2 years after infarction. LDL < 1.8 mmol/L was achieved in 18.5% of the cohort, regular exercise in 45.5% and systolic blood pressure <140 mmHg in 57.0%. Anti-platelet therapy was used by 97% of the patients, beta-blockers by 83.0%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers by 76.5% and statins by 88.5%. During follow-up, non-fatal adverse cardiovascular events (cardiac hospitalization, recurrent acute coronary syndrome, angina pectoris, new percutaneous coronary intervention, new onset of atrial fibrillation, post-infarct heart failure, pacemaker implantation, stroke/transient ischemic attack (TIA), cardiac surgery and cardiac arrest) occurred in 47% of the cohort and readmission due to cardiac causes in 30%.
  
  
  
  Our data showed the failure of secondary prevention in our daily clinical practice and high rate of non-fatal adverse cardiovascular events 2 years after AMI.
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden.
authors.forename: Constantinos
authors.identifier: 0000-0002-8568-7424
authors.initials: C
authors.lastname: Ergatoudes
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Thunström
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden.
authors.forename: Annika
authors.initials: A
authors.lastname: Rosengren
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden.|Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Skövde, Sweden.
authors.forename: Lena
authors.initials: L
authors.lastname: Björck
authors.affiliation: R & D Centre Skaraborg Primary Care, Skövde, Sweden.
authors.forename: Kristina
authors.initials: K
authors.lastname: Bengtsson Boström
authors.affiliation: Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Skövde, Sweden.
authors.forename: Kristin
authors.initials: K
authors.lastname: Falk
authors.affiliation: Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden. Michael.fu@vgregion.se.|Department of Medicine, Section of Cardiology, Sahlgrenska University Hospital/Östra, 41651, Göteborg, Sweden. Michael.fu@vgregion.se.
authors.forename: Michael
authors.initials: M
authors.lastname: Fu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use; D005260:Female; D019983:Guideline Adherence / Q000592:standards*; D006304:Health Status; D006801:Humans; D008019:Life Style; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D010349:Patient Compliance; D063886:Patient Discharge Summaries; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D017064:Process Assessment, Health Care / Q000592:standards*; D018570:Risk Assessment; D012307:Risk Factors; D040242:Risk Reduction Behavior; D055502:Secondary Prevention / Q000592:standards*; D013548:Sweden; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents
keywords: Cardiovascular disease; Long-term; Myocardial infarction; Secondary prevention