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Preventive drug use in patients with a history of nonfatal myocardial infarction during 12-year follow-up in The Netherlands: a retrospective analysis.
Clin Ther. 2005 Nov; 27(11):1806-14.CT

Abstract

BACKGROUND

Myocardial infarction (MI) is a common cause of death in developed countries. Long-term preventive pharmacotherapy has been shown to decrease mortality and morbidity after MI. Based on a literature search, studies of these therapies to date have estimated the use of monotherapy, whereas many patients are prescribed combination therapy. Thus, assessment of long-term combination drug use after MI is timely.

OBJECTIVE

The aim of this study was to assess the use of oral antithrombotics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, hydroxymethyl-glutaryl coenzyme A reductase inhibitors ("statins"), and their combinations after MI at discharge and during 12-year follow-up.

METHODS

This community-based, retrospective data analysis was conducted at Utrecht University, Utrecht, The Netherlands. Data from patients aged > or =18 years at hospital admission who experienced nonfatal acute MI between 1991 and 2000 and had a duration of follow-up > or =30 days were included in the analysis. Data were retrieved from the Pharmo Record Linkage System database, which links pharmacies' dispensation records to hospitals' discharge records on an individual patient level, allowing the investigator to observe individual patients' medication use over time. Primary outcome measures were the use of preventive medicines (oral antithrombotics, beta-blockers, ACE inhibitors, and statins) at discharge, overall use, and persistence during 12-year follow-up.

RESULTS

Of 330,000 patients in the database, 4007 were included in the analysis (2828 men, 1179 women; mean [SD] age, 63.5 [12.5] years). Use at discharge and overall use of oral antithrombotics and statins increased significantly between 1991 and 2000, whereas use of beta-blockers and ACE inhibitors increased mainly in patients discharged in the latter years of the follow-up period. Therapy with any combination of drugs increased strikingly from 1991 to 2000, from 47% to 90%. At 1 year after discharge, 32% of patients had discontinued their first-prescribed combination treatments. At 5 years after discharge, this rate increased to 57%, suggesting a low rate of persistence

CONCLUSIONS

Based on the results of this retrospective data analysis, the use of MI-preventive drug treatment at and after discharge increased significantly in this population in The Netherlands during the 1990s. Combination therapy increased strikingly. However, persistence with combination therapy was low.

Authors+Show Affiliations

Department of Pharmacotherapy and Pharmacoepidemiology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Sorbonnelaan 16, 3584 CA Utrecht, The Netherlands. m.vanderelst@pharm.uu.nlNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

16368451

Citation

van der Elst, Menno E., et al. "Preventive Drug Use in Patients With a History of Nonfatal Myocardial Infarction During 12-year Follow-up in the Netherlands: a Retrospective Analysis." Clinical Therapeutics, vol. 27, no. 11, 2005, pp. 1806-14.
van der Elst ME, Bouvy ML, de Blaey CJ, et al. Preventive drug use in patients with a history of nonfatal myocardial infarction during 12-year follow-up in The Netherlands: a retrospective analysis. Clin Ther. 2005;27(11):1806-14.
van der Elst, M. E., Bouvy, M. L., de Blaey, C. J., & de Boer, A. (2005). Preventive drug use in patients with a history of nonfatal myocardial infarction during 12-year follow-up in The Netherlands: a retrospective analysis. Clinical Therapeutics, 27(11), 1806-14.
van der Elst ME, et al. Preventive Drug Use in Patients With a History of Nonfatal Myocardial Infarction During 12-year Follow-up in the Netherlands: a Retrospective Analysis. Clin Ther. 2005;27(11):1806-14. PubMed PMID: 16368451.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preventive drug use in patients with a history of nonfatal myocardial infarction during 12-year follow-up in The Netherlands: a retrospective analysis. AU - van der Elst,Menno E, AU - Bouvy,Marcel L, AU - de Blaey,Cornelis J, AU - de Boer,Anthonius, PY - 2005/09/29/accepted PY - 2005/12/22/pubmed PY - 2006/3/21/medline PY - 2005/12/22/entrez SP - 1806 EP - 14 JF - Clinical therapeutics JO - Clin Ther VL - 27 IS - 11 N2 - BACKGROUND: Myocardial infarction (MI) is a common cause of death in developed countries. Long-term preventive pharmacotherapy has been shown to decrease mortality and morbidity after MI. Based on a literature search, studies of these therapies to date have estimated the use of monotherapy, whereas many patients are prescribed combination therapy. Thus, assessment of long-term combination drug use after MI is timely. OBJECTIVE: The aim of this study was to assess the use of oral antithrombotics, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, hydroxymethyl-glutaryl coenzyme A reductase inhibitors ("statins"), and their combinations after MI at discharge and during 12-year follow-up. METHODS: This community-based, retrospective data analysis was conducted at Utrecht University, Utrecht, The Netherlands. Data from patients aged > or =18 years at hospital admission who experienced nonfatal acute MI between 1991 and 2000 and had a duration of follow-up > or =30 days were included in the analysis. Data were retrieved from the Pharmo Record Linkage System database, which links pharmacies' dispensation records to hospitals' discharge records on an individual patient level, allowing the investigator to observe individual patients' medication use over time. Primary outcome measures were the use of preventive medicines (oral antithrombotics, beta-blockers, ACE inhibitors, and statins) at discharge, overall use, and persistence during 12-year follow-up. RESULTS: Of 330,000 patients in the database, 4007 were included in the analysis (2828 men, 1179 women; mean [SD] age, 63.5 [12.5] years). Use at discharge and overall use of oral antithrombotics and statins increased significantly between 1991 and 2000, whereas use of beta-blockers and ACE inhibitors increased mainly in patients discharged in the latter years of the follow-up period. Therapy with any combination of drugs increased strikingly from 1991 to 2000, from 47% to 90%. At 1 year after discharge, 32% of patients had discontinued their first-prescribed combination treatments. At 5 years after discharge, this rate increased to 57%, suggesting a low rate of persistence CONCLUSIONS: Based on the results of this retrospective data analysis, the use of MI-preventive drug treatment at and after discharge increased significantly in this population in The Netherlands during the 1990s. Combination therapy increased strikingly. However, persistence with combination therapy was low. SN - 0149-2918 UR - https://www.unboundmedicine.com/medline/citation/16368451/Preventive_drug_use_in_patients_with_a_history_of_nonfatal_myocardial_infarction_during_12_year_follow_up_in_The_Netherlands:_a_retrospective_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0149-2918(05)00282-1 DB - PRIME DP - Unbound Medicine ER -