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Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: a 10-year trend analysis.
J Am Coll Cardiol. 2008 Apr 01; 51(13):1247-54.JACC

Abstract

OBJECTIVES

We sought to assess the relationship between increasing use of cardiovascular medications and trends in long-term prognosis after myocardial infarction (MI) in the elderly.

BACKGROUND

During the past decade, statins, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin-II receptor blockers (ARBs) have been increasingly used after MI. However, little is known about the relationship between increasing use of these medications and improvements in prognosis after MI.

METHODS

Using data from pharmacy assistance programs and Medicare in 2 states (1995 to 2004), we identified patients with MI who survived >or=30 days after discharge. We assessed age, gender, race, comorbidities, and coronary interventions during the MI hospitalization and recorded filled prescriptions for statins, BBs, ACEIs/ARBs, or antiplatelet agents within 30 days after discharge. All patients were tracked until they died or until the end of the eligibility/study period. We built multivariate Cox proportional hazards regression models to assess trends in long-term mortality and the contribution to increasing medication use after MI.

RESULTS

Of 21,484 patients identified, 12,142 died during 74,982 person-years of follow-up. After adjusting for demographics and comorbidities, we found that mortality after MI decreased significantly from 1995 to 2004 (hazard ratio for annual trend 0.97; 95% confidence interval 0.97 to 0.98), a 3% reduction in mortality each year. Adjusting for the use of statins, BBs, ACEIs/ARBs, and antiplatelet drugs after discharge completely eliminated the association between time trend and mortality (hazard ratio 1.00; 95% confidence interval 0.99 to 1.01).

CONCLUSIONS

The observed improvement in long-term mortality in elderly patients with MI may be mainly due to increased use of cardiovascular medications after discharge.

Authors+Show Affiliations

Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02120, USA. soko@post.harvard.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18371553

Citation

Setoguchi, Soko, et al. "Improvements in Long-term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge: a 10-year Trend Analysis." Journal of the American College of Cardiology, vol. 51, no. 13, 2008, pp. 1247-54.
Setoguchi S, Glynn RJ, Avorn J, et al. Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: a 10-year trend analysis. J Am Coll Cardiol. 2008;51(13):1247-54.
Setoguchi, S., Glynn, R. J., Avorn, J., Mittleman, M. A., Levin, R., & Winkelmayer, W. C. (2008). Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: a 10-year trend analysis. Journal of the American College of Cardiology, 51(13), 1247-54. https://doi.org/10.1016/j.jacc.2007.10.063
Setoguchi S, et al. Improvements in Long-term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge: a 10-year Trend Analysis. J Am Coll Cardiol. 2008 Apr 1;51(13):1247-54. PubMed PMID: 18371553.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: a 10-year trend analysis. AU - Setoguchi,Soko, AU - Glynn,Robert J, AU - Avorn,Jerry, AU - Mittleman,Murray A, AU - Levin,Raisa, AU - Winkelmayer,Wolfgang C, PY - 2007/07/23/received PY - 2007/10/12/revised PY - 2007/10/17/accepted PY - 2008/3/29/pubmed PY - 2008/4/30/medline PY - 2008/3/29/entrez SP - 1247 EP - 54 JF - Journal of the American College of Cardiology JO - J Am Coll Cardiol VL - 51 IS - 13 N2 - OBJECTIVES: We sought to assess the relationship between increasing use of cardiovascular medications and trends in long-term prognosis after myocardial infarction (MI) in the elderly. BACKGROUND: During the past decade, statins, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin-II receptor blockers (ARBs) have been increasingly used after MI. However, little is known about the relationship between increasing use of these medications and improvements in prognosis after MI. METHODS: Using data from pharmacy assistance programs and Medicare in 2 states (1995 to 2004), we identified patients with MI who survived >or=30 days after discharge. We assessed age, gender, race, comorbidities, and coronary interventions during the MI hospitalization and recorded filled prescriptions for statins, BBs, ACEIs/ARBs, or antiplatelet agents within 30 days after discharge. All patients were tracked until they died or until the end of the eligibility/study period. We built multivariate Cox proportional hazards regression models to assess trends in long-term mortality and the contribution to increasing medication use after MI. RESULTS: Of 21,484 patients identified, 12,142 died during 74,982 person-years of follow-up. After adjusting for demographics and comorbidities, we found that mortality after MI decreased significantly from 1995 to 2004 (hazard ratio for annual trend 0.97; 95% confidence interval 0.97 to 0.98), a 3% reduction in mortality each year. Adjusting for the use of statins, BBs, ACEIs/ARBs, and antiplatelet drugs after discharge completely eliminated the association between time trend and mortality (hazard ratio 1.00; 95% confidence interval 0.99 to 1.01). CONCLUSIONS: The observed improvement in long-term mortality in elderly patients with MI may be mainly due to increased use of cardiovascular medications after discharge. SN - 1558-3597 UR - https://www.unboundmedicine.com/medline/citation/18371553/Improvements_in_long_term_mortality_after_myocardial_infarction_and_increased_use_of_cardiovascular_drugs_after_discharge:_a_10_year_trend_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0735-1097(08)00229-5 DB - PRIME DP - Unbound Medicine ER -