scholarly journals Passive Prescription of Secondary Prevention Medical Therapy During Index Hospitalization for Acute Myocardial Infarction is Prevalent and Associated with Adverse Clinical Outcomes

2020 ◽  
Author(s):  
Nancy Xu-Rui Huang ◽  
Fang Fang ◽  
Yizhou Xu ◽  
Jinyu Huang ◽  
John E. Sanderson ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Multivariate Analysis ◽  
Secondary Prevention ◽  
Clinical Outcomes ◽  
Beta Blockers ◽  
Left Ventricular Ejection ◽  
Index Hospitalization ◽  
Prevention Therapy ◽  
Prescription Rates

Abstract Background: Secondary prevention therapy reduces death and re-infarction after acute myocardial infarction (AMI) but is under-utilized in clinical practice. Mechanisms for this therapeutic gap are not well established. We aimed to evaluate the impact of passive continuation compared to active initiation of secondary prevention therapy for AMI patients during index hospitalization. Methods: We analyzed 1083 consecutive patients with AMI to a tertiary referral hospital in Hong Kong and assessed discharge prescription rates of secondary prevention therapies (aspirin, clopidogrel, beta-blockers, statins, angiotensin-converting enzyme inhibitor or angiotensin II receptor blockers (ACEI/ARBs)). Multivariate analysis was used to identify independent predictors of discharge and 6-month medication, Kaplan-Meier survival curve was used to evaluate 12-month survival. Results: Overall prescription rates of aspirin, clopidogrel, beta-blockers, statins, ACEI/ARBs on discharge was 94.8%, 54.2%, 64.5%, 83.5% and 61.4%, respectively. Multivariate analysis showed that prior use of each therapy, except clopidogrel, was an independent predictor of prescription of the same therapy on discharge: aspirin [Odds ratio (OR) =4.8, 95% CI =1.9-12.3, P<0.01]; beta-blockers (OR=2.5, 95%CI =1.8-3.4, P<0.01); statins (OR=8.3, 95%CI =0.4-15.7, P<0.01) and ACEI/ARBs (OR=2.9, 95%CI =2.0-4.3, P<0.01). Passive continuation of prior medication was associated with higher 1-year mortality rates than active initiation in treatment naïve patient [aspirin (13.7% vs. 5.7%), beta-blockers (12.9% vs. 5.6%), statins (11.0% vs. 4.6%), all P<0.01].Active prescription was more common in lower risk patients (who were younger, with less co-morbidity, and with higher left ventricular ejection fraction) who were treated more aggressively with secondary prevention medication on discharge. Also patients who were not on a given medication before admission were less likely to be prescribed it on discharge.Conclusions: Overall use of secondary prevention medication for AMI was suboptimal compared to guideline recommendations. Our findings suggested the practice of passive continuation of prior medication was prevalent and associated with adverse clinical outcomes compared to those who received secondary preventive medication for the first time during index hospitalization. Failure to start additional medication and possible inadequate dose titration in the passive continuation group may be in part the reason for the poorer clinical outcome in this group.

scholarly journals Passive Prescription of Secondary Prevention Medical Therapy during Index Hospitalization for Acute Myocardial Infarction Is Prevalent and Associated with Adverse Clinical Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Nancy Xurui Huang ◽  
John E. Sanderson ◽  
Fang Fang ◽  
Cheuk-Man Yu ◽  
Bryan P. Yan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Multivariate Analysis ◽  
Secondary Prevention ◽  
Clinical Outcomes ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Index Hospitalization ◽  
Prevention Therapy ◽  
Prescription Rates

Secondary prevention therapy reduces death and reinfarction after acute myocardial infarction (AMI), but it is underutilized in clinical practice. Mechanisms for this therapeutic gap are not well established. In this study, we have explored and evaluated the impact of passive continuation compared to active initiation of secondary prevention therapy for AMI during the index hospitalization. For this purpose, we have analyzed 1083 consecutive patients with AMI to a tertiary referral hospital in Hong Kong and assessed discharge prescription rates of secondary prevention therapies (aspirin, beta-blockers, statins, and ACEI/ARBs). Multivariate analysis was used to identify independent predictors of discharge medication, and Kaplan–Meier survival curve was used to evaluate 12-month survival. Overall, prescription rates of aspirin, beta-blocker, statin, and ACEI/ARBs on discharge were 94.8%, 64.5%, 83.5%, and 61.4%, respectively. Multivariate analysis showed that prior use of each therapy was an independent predictor of prescription of the same therapy on discharge: aspirin (odds ratio (OR) = 4.8, 95% CI = 1.9–12.3, P < 0.01 ), beta-blocker (OR = 2.5, 95% CI = 1.8–3.4, P < 0.01 ); statin (OR = 8.3, 95% CI = 0.4–15.7, P < 0.01 ), and ACEI/ARBs (OR = 2.9, 95% CI = 2.0–4.3, P < 0.01 ). Passive continuation of prior medication was associated with higher 1-year mortality rates than active initiation in treatment-naïve patients (aspirin (13.7% vs. 5.7%), beta-blockers (12.9% vs. 5.6%), and statins (11.0% vs. 4.6%); all P < 0.01 ). Overall, the use of secondary prevention medication for AMI was suboptimal. Our findings suggested that the practice of passive continuation of prior medication was prevalent and associated with adverse clinical outcomes compared to active initiation of secondary preventive therapies for acute myocardial infarction during the index hospitalization.

Abstract 12691: Long-term Optimal Medical Therapy for Patients With Mid-range Left Ventricular Ejection Fraction After Acute Myocardial Infarction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
YeeKyoung KO ◽  
Seungjae JOO ◽  
Jong Wook Beom ◽  
Jae-Geun Lee ◽  
Joon-Hyouk CHOI ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricular Ejection Fraction ◽  
Medical Therapy ◽  
Beta Blockers ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Ras Inhibitors

Introduction: In the era of the initial optimal interventional and medical therapy for acute myocardial infarction (AMI), a number of patients with mid-range left ventricular ejection fraction (40% <EF<50%) becomes increasing. However, the long-term optimal medical therapy for these patients has been rarely studied. Aims: This observational study aimed to investigate the association between the medical therapy with beta-blockers or inhibitors of renin-angiotensin system (RAS) and clinical outcomes in patients with mid-range EF after AMI. Methods: Among 13,624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), propensity-score matched patients who survived the initial attack and had mid-range EF were selected according to beta-blocker or RAS inhibitor therapy at discharge. Results: Patients with beta-blockers showed significantly lower 1-year cardiac death (2.4 vs. 5.2/100 patient-year; hazard ratio [HR] 0.46; 95% confidence interval [CI] 0.22-0.98; P =0.045) and MI (1.7 vs. 4.0/100 patient-year; HR 0.41; 95% CI 0.18-0.95; P =0.037). On the other hand, RAS inhibitors were associated with lower 1-year re-hospitalization due to heart failure (2.8 vs. 5.5/100 patient-year; HR 0.54; 95% CI 0.31-0.92; P =0.024), and no significant interaction with classes of RAS inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers) was observed ( P for interaction=0.332). Conclusions: Beta-blockers or RAS inhibitors at discharge were associated with better 1-year clinical outcomes in patients with mid-range EF after AMI.

P6424The association between long-term beta-blocker use and outcome in a contemporary large-scale cohort of patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C X Song ◽  
R Fu ◽  
J G Yang ◽  
K F Dou ◽  
Y J Yang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blocker ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Baseline Characteristics

Abstract Background Controversy exists regarding the use of beta-blockers (BBs) among patients with acute myocardial infarction (AMI) in contemporary reperfusion era. Previous studies predominantly focused on beta-blockers prescribed at discharge, and the effect of long-term adherence to beta-blocker on major adverse cardiovascular events (MACE) remains unclear. Objective To explore the association between long-term beta-blocker use patterns and MACE among contemporary AMI patients. Methods We enrolled 7860 patients with AMI, who were discharged alive and prescribed with BBs based on CAMI registry from January 2013 to September 2014. Patients were divided into two groups according to BBs use pattern: Always users group (n=4476) were defined as patients reporting BBs use at both 6- and 12-month follow-up; Inconsistent users group were defined as patients reporting at least once not using BBs at 6- or 12-month follow-up. Primary outcome was defined as MACE at 24-month follow-up, including all-cause death, non-fatal MI and repeat-revascularization. Multivariable cox proportional hazards regression model was used to assess the association between BBs and MACE. Results Baseline characteristics are shown in table 1. At 2-year follow-up, 518 patients in inconsistent users group (15.6%) and 548 patients in always users group (12.3%) had MACE. After multivariable adjustment, inconsistent use of BBs was associated with higher risk of MACE (HR: 1.323, 95% CI: 1.171–1.493, p<0.001). Table 1 Baseline characteristics Variable Always user (N=4476) Inconsistent user (N=3384) P value Age (years) 60.6±12.0 61.2±12.2 <0.001 Male 3381 (75.7%) 2461 (74.3%) 0.084 Diabetes 892 (20.0%) 610 (18.4%) 0.003 Hypertension 2372 (53.2%) 1543 (46.6%) <0.001 Dyslipidemia 244 (5.5%) 126 (3.8%) <0.001 Prior myocardial infarction 351 (7.9%) 232 (7.0%) <0.001 Heart failure 88 (2.0%) 63 (1.9%) <0.001 Chronic obstructive pulmonary disease 66 (1.5%) 60 (1.8%) <0.001 Current smoker 2054 (46.1%) 1579 (47.8%) 0.179 Left ventricular ejection fraction (%) 53.7±11.48 54.0±10.9 <0.001 Major Adverse Cardiovascular Events 548 (12.3%) 518 (15.6%) <0.001 Conclusions Our results showed consistent BBs use was associated with reduced risk of MACE among patients with AMI managed by contemporary treatment. Acknowledgement/Funding CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

scholarly journals Beta-blockers and renin-angiotensin system inhibitors in acute myocardial infarction managed with inhospital coronary revascularization

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hui Wen Sim ◽  
Huili Zheng ◽  
A. Mark Richards ◽  
Ruth W. Chen ◽  
Anders Sahlen ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Lower Incidence ◽  
Beta Blockers ◽  
Angiotensin Receptor Blockers ◽  
Coronary Revascularization ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
All Cause Mortality

Abstract Pivotal trials of beta-blockers (BB) and angiotensin converting enzyme inhibitors/angiotensin receptor blockers (ACEI/ARB) in acute myocardial infarction (AMI) were largely conducted prior to the widespread adoption of early revascularization. A total of 15,073 patients with AMI who underwent inhospital coronary revascularization from January 2007 to December 2013 were analyzed. At 12 months, BB was significantly associated with a lower incidence of major adverse cardiovascular events (MACE, adjusted HR 0.80, 95% CI 0.70–0.93) and all-cause mortality (adjusted HR 0.69, 95% CI 0.55–0.88), while ACEI/ARB was significantly associated with lower all-cause mortality (adjusted HR 0.80, 95% CI 0.66–0.98) and heart failure (HF) hospitalization (adjusted HR 0.80, 95% CI 0.68–0.95). Combined BB and ACEI/ARB use was associated with the lowest incidence of MACE (adjusted HR 0.70, 95% CI 0.57–0.86), all-cause mortality (adjusted HR 0.55, 95% CI 0.40–0.77) and HF hospitalization (adjusted HR 0.64, 95% CI 0.48–0.86). This were consistent for left ventricular ejection fraction < 50% or ≥ 50%. In conclusion, in AMI managed with revascularization, both BB and ACEI/ARB were associated with a lower incidence of 12-month all-cause mortality. Combined BB and ACEI/ARB was associated with the lowest incidence of all-cause mortality and HF hospitalization.

Effect of beta-blocker therapy in patients with or without left ventricular systolic dysfunction after acute myocardial infarction

2020 ◽  
Author(s):  
Seung-Jae Joo ◽  
Song-Yi Kim ◽  
Joon-Hyouk Choi ◽  
Hyeung Keun Park ◽  
Jong Wook Beom ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Outcomes ◽  
Beta Blocker ◽  
Left Ventricular Systolic Dysfunction ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Blocker Therapy ◽  
Beta Blocker Therapy

Abstract Aims This observational study aimed to investigate the association between beta-blocker therapy and clinical outcomes in patients with acute myocardial infarction (AMI), especially with mid-range or preserved left ventricular systolic function. Methods and results Among 13 624 patients enrolled in the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH), 12 200 in-hospital survivors were selected. Patients with beta-blockers showed significantly lower 1-year major adverse cardiac events (MACE), which was a composite of cardiac death, MI, revascularization, and readmission due to heart failure [9.7 vs. 14.3/100 patient-year; hazard ratio (HR) 0.84, 95% confidence interval (CI) 0.72–0.97; P = 0.022). However, this association had a significant interaction with left ventricular ejection fraction (LVEF). Beta-blocker therapy at discharge was associated with lower 1-year MACE in patients with LVEF ≤40% (HR 0.63, 95% CI 0.48–0.81; P &lt; 0.001), and 40% &lt;LVEF &lt; 50% (HR 0.69, 95% CI 0.51–0.94; P = 0.020), but not in patients with LVEF ≥50% (HR 1.16, 95% CI 0.91–1.48; P = 0.234). Conclusions Beta-blocker therapy at discharge was associated with better 1-year clinical outcomes in patients with reduced or mid-range LVEF after AMI, but not in patients with preserved LVEF. These data suggested that the long-term beta-blocker therapy may be guided by LVEF.

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