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Suboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: prescription rate, predictors, and prognostic value.
Am Heart J. 2010 Jun; 159(6):1012-9.AH

Abstract

BACKGROUND

Only limited data are available for the recent trend of optimal evidence-based medical therapy at discharge after acute myocardial infarction (AMI) in Asia. We evaluated the predictors for the use of optimal evidence-based medical therapy at discharge and the association between discharge medications and 6-month mortality after AMI.

METHODS

Between November 2005 and January 2008, we evaluated the discharge medications among 9,294 post-MI survivors who did not have any documented contraindications to antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors (ACE-Is)/angiotensin II receptor blockers (ARBs), or statins in the Korea Acute Myocardial Infarction Registry. Optimal evidence-based medical therapy was defined as the use of all 4 indicated medications.

RESULTS

Of these patients, 4,684 (50.4%) received all 4 medications at discharge. The discharge prescription rates of antiplatelet drugs, beta-blockers, ACE-Is/ARBs, and statins were 99.0%, 72.7%, 81.5%, and 77.2%, respectively. In multivariate analysis, advanced age, lower systolic blood pressure, higher Killip class at admission, left ventricular systolic dysfunction, higher blood creatinine level, lower total cholesterol levels, and coronary artery bypass grafting during hospitalization were independently associated with less use of optimal evidence-based medical therapy. In contrast, patients who underwent percutaneous coronary intervention were more likely to use optimal medications. In Cox proportional hazards model, optimal evidence-based medical therapy was an independent predictor of 6-month mortality after adjusting clinical characteristics and angiographic and procedural data.

CONCLUSIONS

The optimal evidence-based medical therapy is prescribed at suboptimal rates, particularly in patients with high-risk features. New educational strategies are needed to increase the use of these secondary preventive medical therapies.

Authors+Show Affiliations

Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Multicenter Study
Randomized Controlled Trial

Language

eng

PubMed ID

20569714

Citation

Lee, Jang Hoon, et al. "Suboptimal Use of Evidence-based Medical Therapy in Patients With Acute Myocardial Infarction From the Korea Acute Myocardial Infarction Registry: Prescription Rate, Predictors, and Prognostic Value." American Heart Journal, vol. 159, no. 6, 2010, pp. 1012-9.
Lee JH, Yang DH, Park HS, et al. Suboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: prescription rate, predictors, and prognostic value. Am Heart J. 2010;159(6):1012-9.
Lee, J. H., Yang, D. H., Park, H. S., Cho, Y., Jeong, M. H., Kim, Y. J., Kim, K. S., Hur, S. H., Seong, I. W., Hong, T. J., Cho, M. C., Kim, C. J., Jun, J. E., Park, W. H., & Chae, S. C. (2010). Suboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: prescription rate, predictors, and prognostic value. American Heart Journal, 159(6), 1012-9. https://doi.org/10.1016/j.ahj.2010.03.009
Lee JH, et al. Suboptimal Use of Evidence-based Medical Therapy in Patients With Acute Myocardial Infarction From the Korea Acute Myocardial Infarction Registry: Prescription Rate, Predictors, and Prognostic Value. Am Heart J. 2010;159(6):1012-9. PubMed PMID: 20569714.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Suboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: prescription rate, predictors, and prognostic value. AU - Lee,Jang Hoon, AU - Yang,Dong Heon, AU - Park,Hun Sik, AU - Cho,Yongkeun, AU - Jeong,Myung Ho, AU - Kim,Young Jo, AU - Kim,Kee-Sik, AU - Hur,Seung Ho, AU - Seong,In Whan, AU - Hong,Taek Jong, AU - Cho,Myeong Chan, AU - Kim,Chong Jin, AU - Jun,Jae-Eun, AU - Park,Wee-Hyun, AU - Chae,Shung Chull, AU - ,, PY - 2009/12/29/received PY - 2010/03/04/accepted PY - 2010/6/24/entrez PY - 2010/6/24/pubmed PY - 2010/7/16/medline SP - 1012 EP - 9 JF - American heart journal JO - Am Heart J VL - 159 IS - 6 N2 - BACKGROUND: Only limited data are available for the recent trend of optimal evidence-based medical therapy at discharge after acute myocardial infarction (AMI) in Asia. We evaluated the predictors for the use of optimal evidence-based medical therapy at discharge and the association between discharge medications and 6-month mortality after AMI. METHODS: Between November 2005 and January 2008, we evaluated the discharge medications among 9,294 post-MI survivors who did not have any documented contraindications to antiplatelet drugs, beta-blockers, angiotensin-converting enzyme inhibitors (ACE-Is)/angiotensin II receptor blockers (ARBs), or statins in the Korea Acute Myocardial Infarction Registry. Optimal evidence-based medical therapy was defined as the use of all 4 indicated medications. RESULTS: Of these patients, 4,684 (50.4%) received all 4 medications at discharge. The discharge prescription rates of antiplatelet drugs, beta-blockers, ACE-Is/ARBs, and statins were 99.0%, 72.7%, 81.5%, and 77.2%, respectively. In multivariate analysis, advanced age, lower systolic blood pressure, higher Killip class at admission, left ventricular systolic dysfunction, higher blood creatinine level, lower total cholesterol levels, and coronary artery bypass grafting during hospitalization were independently associated with less use of optimal evidence-based medical therapy. In contrast, patients who underwent percutaneous coronary intervention were more likely to use optimal medications. In Cox proportional hazards model, optimal evidence-based medical therapy was an independent predictor of 6-month mortality after adjusting clinical characteristics and angiographic and procedural data. CONCLUSIONS: The optimal evidence-based medical therapy is prescribed at suboptimal rates, particularly in patients with high-risk features. New educational strategies are needed to increase the use of these secondary preventive medical therapies. SN - 1097-6744 UR - https://www.unboundmedicine.com/medline/citation/20569714/Suboptimal_use_of_evidence_based_medical_therapy_in_patients_with_acute_myocardial_infarction_from_the_Korea_Acute_Myocardial_Infarction_Registry:_prescription_rate_predictors_and_prognostic_value_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0002-8703(10)00234-6 DB - PRIME DP - Unbound Medicine ER -