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

Title
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
Author(s)
김영조이장훈[이장훈]양동헌[양동헌]박훈식[박훈식]조용근[조용근]정명호[정명호]김기식[김기식]허성호[허성호]성인환[성인환]홍택종[홍택종]조명찬[조명찬]김종진[김종진]전재은[전재은]박위현[박위현]채성철[채성철]
Keywords
ACUTE CORONARY SYNDROMES; QUALITY-OF-CARE; ELDERLY-PATIENTS; MORTALITY; MANAGEMENT; RISK; DISCHARGE; JAPANESE; COLLEGE; PROJECT
Issue Date
201003
Publisher
MOSBY-ELSEVIER
Citation
AMERICAN HEART JOURNAL, v.159, no.6, pp.1012 - 1019
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. (Am Heart J 2010; 159:1012-9.)
URI
http://hdl.handle.net/YU.REPOSITORY/22747http://dx.doi.org/10.1016/j.ahj.2010.03.009
ISSN
0002-8703
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의과대학 > 내과학교실 > Articles
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