Use and adherence to beta-blockers for secondary prevention of myocardial infarction: who is not getting the treatment?

2004 ◽  
Vol 13 (11) ◽  
pp. 761-766 ◽  
Author(s):  
Li Wei ◽  
Robert Flynn ◽  
Gordon D. Murray ◽  
Thomas M. MacDonald
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Beta Blockers

Mortality and Reinfarction among Patients Using Different Beta-Blockers for Secondary Prevention after a Myocardial Infarction

Cardiology ◽  
2009 ◽  
Vol 112 (2) ◽  
pp. 144-150 ◽  
Author(s):  
Søren Skøtt Andersen ◽  
Morten Lock Hansen ◽  
Gunnar H. Gislason ◽  
Fredrik Folke ◽  
Tina Ken Schramm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Beta Blockers

Abstract P331: Secondary Prevention After Acute Coronary Syndrome with Microsize Myocardial Infarctions in the Reasons for Geographic and Racial Differences in Stroke-Myocardial Infarction (REGARDS-MI) Study

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Niket Nathani ◽  
Monika M Safford ◽  
Christopher Gamboa ◽  
Mallika Mundkur ◽  
Shannon Preston ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Coronary Syndrome ◽  
Secondary Prevention ◽  
Racial Differences ◽  
Cardiac Troponin ◽  
Beta Blockers ◽  
Community Dwelling ◽  
Prevention Measures ◽  
Coronary Syndrome ◽  
Similar Range

Background: Studies have shown increased mortality after myocardial infarction (MI) with low level elevations of cardiac troponin (“microsize MI”) and subsequent risk reduction with intensive medical management. However, non-standard reporting and highly sensitive assays of cardiac troponin can make the clinical recognition of microsize MI difficult, creating barriers to the implementation of appropriate secondary prevention. Methods: REGARDS follows 30,239 community-dwelling participants of the 48 continental states age ≥45 years recruited from 2003-7; 41% of the sample was African American and 55% female by design. Following national consensus guidelines, experts adjudicated cases of acute coronary syndrome (ACS), defined as an admission for acute signs or symptoms of ischemia, and MI from hospital records. We studied first cases of ACS, classified as: 1) ACS without MI, 2) ACS+microsize MI (peak troponin <0.5), and 3) ACS+usual MI (peak troponin ≥0.5), to compare whether secondary prevention medications were prescribed at hospital discharge among these 3 groups. We used multivariable logistic regression to examine odds ratios for receipt of medications at discharge associated with microsize MI and no MI relative to usual MI. Results: The 1,238 cases of ACS were mean age 68.0+/-8.7 years, 59% male, and 66% white. Of these, 917 had discharge medications available. Compared to those with ACS+usual MI, individuals with ACS+microsize MI had lower odds of receiving beta-blockers and statins at discharge in a similar range as those without MI ( Table ). Conclusion: Individuals hospitalized for ACS and microsize MI were less likely to receive guideline appropriate secondary prevention measures than those with usual MI.

scholarly journals Studies of the outcome of the treatment with beta-blockers in secondary prevention of the ischemic heart disease

2009 ◽  
Vol 62 (9-10) ◽  
pp. 450-455 ◽  
Author(s):  
Vesna Radovic
Keyword(s):  
Myocardial Infarction ◽  
Heart Disease ◽  
Angina Pectoris ◽  
Secondary Prevention ◽  
Ischemic Heart Disease ◽  
Beta Blockers ◽  
Convincing Evidence ◽  
Ischemic Heart ◽  
Necessary Condition ◽  
Professional Literature

Convincing evidence of the decline of mortality has been achieved with beta-blockers in patients with an acute myocardial infarction and in post-infarction follow-up. The beta-blockers are also the most efficient antianginal medications for the decrease of ischemia in outpatients. They are highly efficient as a monotherapy for angina and are also a medication of choice for angina after the coronary. The objective of this work was an estimate of the use of beta-blockers in secondary prevention of the ischemic heart disease and eliminating doubts concerning their prescription. The method of the analysis sums up the results of a twenty-five- year study on of the outcome of the treatment with beta-blockers in secondary prevention of the ischemic heart disease. The method of the work implies an examination of the professional literature and the data-bases, such as MEDLINE, PubMed and KOBSON. The first studies concerned non-selective beta-blockers, used orally. The following studies concerned cardioselective beta-blockers, metoprolol and atenolol. Several studies followed also the effect of beta-blockers and heparin, or beta-blockers and antagonists of calcium towards placebo, in patients with an unstable angina pectoris. Beta-blockers are an essential drug in secondary prevention of the myocardial infarction and in chronic heart failure. The necessary condition for the efficiency of beta-blockers is an early use. Beta-blockers should be given within 12 hours after the appearance of pain. The continuation of the therapy with beta-blockers after the acute phase is considered to be important in the decrease of the infarction zone expansion. Prophylactic use of beta-blockers after the coronary has an excellent effect, above all in patients with a minor, uncomplicated coronary. Though certain groups of beta-blockers have some special characteristics, when it comes to the treatment of angina pectoris, all beta-blockers are efficient. Generally, patients react well to them. Preference is given to cardioselective remedies, in patients with diabetes or lung disease. Exhaustive controlled clinical studies affirm beta-blockers as drugs that reduce mortality in secondary prevention of the ischemic heart disease.

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 Adherence to recommendations for secondary prevention medications after myocardial infarction in Estonia

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
P Loiveke ◽  
T Marandi ◽  
T Ainla ◽  
K Fischer ◽  
J Eha
Keyword(s):  
Myocardial Infarction ◽  
Medication Adherence ◽  
Secondary Prevention ◽  
Angiotensin Converting Enzyme ◽  
Beta Blockers ◽  
Converting Enzyme ◽  
Total N ◽  
Study Population ◽  
Receptor Blockers

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Estonian Research Council Introduction High rates of adherence to myocardial infarction (MI) secondary prevention medications have been reported by several studies in Europe.  However, results derived from unselected populations registry based data is scarce. Purpose Aim of our study was to analyse adherence to guideline recommended medications for secondary prevention of MI of unselected patient population in Estonia in 2017-2018 and compare the results with data from 2004-2005. Methods Population studied in 2004-2005 was based on Estonian Health Insurance Fund"s (EHIF) database and in 2017-2018 on Estonian Myocardial Infarction Registry (EMIR). EMIR is an ongoing registry recording data from all patients in Estonia diagnosed with MI (ICD-10 I21 – I22). Patients hospitalised due to MI and survived &gt; 30 days formed the study population. By linking to EHIF"s prescription database medication adherence for angiotensin converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARB), statins, beta blockers (BB) and P2Y12 inhibitors clopidogrel and ticagrelor was assessed during one year follow-up period from first hospitalisation during period studied (at least one reimbursed prescription for the drug group during follow-up period). Results 4900 and 5067 index episodes were defined in 2004-2005 and 2017-2018, respectively. Mean age in the study population was 64.7 (+/- 11.5) and 66.5 (+/- 12.1) for men and 72.7 +/- 9.9 and 76.4 +/- 10.9 for women in 2004-2005 and 2017-2018. Rates of medication adherence among patients who survived &gt; 30 days are presented in the Table. Conclusion Adherence to guideline recommended medication for secondary prevention of MI in Estonia has improved considerably over 13 years. Based on our data there is room for advancement, especially among women and the elderly. Rates of medication adherence.2004-20052017-2018p value (comparison between studies)MEN (n = 2365)WOMEN (n = 1660)TOTAL (n = 4025)MEN (n = 2704)WOMEN (n = 1668)TOTAL (n = 4372)BB, No. (%)1907 (80.6)1344 (81.0)3251 (81.0)2265 (84.0)1385 (83.0)3650 (83.5)0.001ACE/ARB, No. (%)1780 (75.3)1317 (79.3)3097 (76.9)1817 (67.2)1070 (64.1)2887 (66.0)&lt; 0.001Statins, No. (%)946 (40.0)826 (50.0)*1772 (44.0)1910 (70.6)1020 (61.2)*2930 (67.0)&lt; 0.001Statin + ACE/ARB + BB, No. (%)999 (42.2)647 (39.0)1646 (40.9)1336 (49.4)686 (41.1)*2022 (46.2)&lt; 0.001None of the above medications, No. (%)130 (5.5)96 (6.0)226 (5.6)214 (7.9)148 (9.0)362 (8.3)&lt; 0.001P2Y12 inhibitorsNANANA2194 (81.1)1147 (69.0)*3341 (76.4)NABB, beta-blockers; ACE/ARB, angiotensin converting enzyme inhibitors/angiotensin II receptor blockers. NA, not available *P &lt; 0.01 for comparison between men and women with Pearson"s χ2 test. Pearson"s χ2 test used for comparison between studies.

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