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Longitudinal persistence with secondary prevention therapies relative to patient risk after myocardial infarction.


ABSTRACT: Prior studies have demonstrated that patients with high-risk acute myocardial infarction (AMI) are less likely to receive guideline-directed medications during hospitalisation. It is unknown if this paradox persists following discharge. We aimed to assess if persistence with guideline-directed medications post discharge varies by patients' risk following AMI.Data were analysed from two prospective, multicentre US AMI registries. The primary outcome was persistence with all prescribed guideline-directed medications (aspirin, ?-blockers, statins, angiotensin-antagonists) at 1, 6 and 12 months post discharge. The association between risk and medication persistence post discharge was assessed using multivariable mixed-effect models.Among 6434 patients with AMI discharged home, 2824 were considered low-risk, 2014 intermediate-risk and 1596 high-risk for death based upon their Global Registry of Acute Coronary Event (GRACE) 6-month risk score. High-risk was associated with a lower likelihood of receiving all appropriate therapies at discharge compared with low-risk patients (relative risk (RR) 0.90; 95% CI 0.87 to 0.94). At 12 months, the rate of persistence with all prescribed therapies was 61.5%, 57.9% and 45.9% among low-risk, intermediate-risk and high-risk patients, respectively. After multivariable adjustment, high-risk was associated with lower persistence with all prescribed medications (RR 0.87; 95% CI 0.82 to 0.92) over follow-up. Similar associations were seen for individual medications. Over the 5?years of the study, persistence with prescribed therapies post discharge improved modestly among high-risk patients (RR 1.05; 95% CI 1.03 to 1.08 per year).High-risk patients with AMI have a lower likelihood of persistently taking prescribed medications post discharge as compared with low-risk patients. Continued efforts are needed to improve the use of guideline-directed medications in high-risk patients.

SUBMITTER: Shore S 

PROVIDER: S-EPMC4871817 | biostudies-literature | 2015 May

REPOSITORIES: biostudies-literature

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Longitudinal persistence with secondary prevention therapies relative to patient risk after myocardial infarction.

Shore Supriya S   Jones Philip G PG   Maddox Thomas M TM   Bradley Steven M SM   Stolker Joshua M JM   Arnold Suzanne V SV   Parashar Susmita S   Peterson Pamela P   Bhatt Deepak L DL   Spertus John J   Ho P Michael PM  

Heart (British Cardiac Society) 20150323 10


<h4>Background</h4>Prior studies have demonstrated that patients with high-risk acute myocardial infarction (AMI) are less likely to receive guideline-directed medications during hospitalisation. It is unknown if this paradox persists following discharge. We aimed to assess if persistence with guideline-directed medications post discharge varies by patients' risk following AMI.<h4>Methods</h4>Data were analysed from two prospective, multicentre US AMI registries. The primary outcome was persiste  ...[more]

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