Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: a 10-year trend analysis.

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: Soko Setoguchi, Robert J Glynn, Jerry Avorn, Murray A Mittleman, Raisa Levin, Wolfgang C Winkelmayer
• Journal: Journal of the American College of Cardiology (J Am Coll Cardiol) Vol. 51 Issue 13 Pg. 1247-54 (Apr 01 2008) ISSN: 1558-3597 [Electronic] United States
• PMID: 18371553 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Adrenergic beta-Antagonists
• Angiotensin II Type 1 Receptor Blockers
• Angiotensin-Converting Enzyme Inhibitors
• Cardiovascular Agents
• Hypolipidemic Agents

Topics

• Adrenergic beta-Antagonists (therapeutic use)
• Age Factors
• Aged
• Aged, 80 and over
• Angiotensin II Type 1 Receptor Blockers (therapeutic use)
• Angiotensin-Converting Enzyme Inhibitors (therapeutic use)
• Cardiovascular Agents (therapeutic use)
• Female
• Follow-Up Studies
• Humans
• Hypolipidemic Agents (therapeutic use)
• Length of Stay
• Male
• Mortality (trends)
• Myocardial Infarction (drug therapy, mortality, physiopathology)
• Patient Discharge
• Prognosis
• Proportional Hazards Models
• Retrospective Studies
• Time Factors
• Treatment Outcome