Secondary Prevention Medication After Myocardial Infarction: Persistence in Elderly People over the Course of 1?Year

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• 作者：Saba Al-Khadra (1) (2)
  Christa Meisinger (1) (2)
  Ute Amann (1) (2)
  Rolf Holle (3)
  Bernhard Kuch (4) (5)
  Hildegard Seidl (3)
  Inge Kirchberger (1) (2)
  
• 刊名：Drugs & Aging
• 出版年：2014
• 出版时间：July 2014
• 年：2014
• 卷：31
• 期：7
• 页码：513-525
• 全文大小：303 KB
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• 作者单位：Saba Al-Khadra (1) (2)
  Christa Meisinger (1) (2)
  Ute Amann (1) (2)
  Rolf Holle (3)
  Bernhard Kuch (4) (5)
  Hildegard Seidl (3)
  Inge Kirchberger (1) (2)
  
  1. Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
  2. Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany
  3. Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany
  4. Department of Internal Medicine/Cardiology, Hospital of N?rdlingen, N?rdlingen, Germany
  5. Department of Internal Medicine I, Cardiology, Central Hospital of Augsburg, Augsburg, Germany
  
• ISSN：1179-1969

文摘

Aims Persistent use of guideline-recommended drugs after acute myocardial infarction (AMI) is frequently reported to be inadequate in the elderly and scarce knowledge exists about factors that influence persistence in outpatient care. Our aim was to evaluate drug use and its predictors in survivors of AMI above 64?years from hospital discharge to 1-year post-AMI. Methods In a single-centre randomised controlled trial, discharge medication of 259 patients with AMI was obtained from medical records at hospital stay. Follow-up drug use and use of the healthcare system were self-reported to study nurses over 1?year in 3-month intervals. Predictors for persistence were modelled with multivariate logistic regression analysis considering demographics, co-morbidities and treatment characteristics. Results At discharge, 99.2?% of the patients used anti-platelets, 86.5?% beta blockers, 95.0?% statins and 90.4?% angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Use of the combination of all four drug classes decreased from discharge to 1?year post-AMI from 74.1 to 37.8?% and was significantly reduced by age ?5?years (odds ratio [OR] 0.49; 95?% confidence interval [CI] 0.29-.85) and ten or more visits with general practitioners (GPs) over 1 year (OR 0.29; 95?% CI 0.17-.51). Persistence from month 3 to 12 was significantly associated with drug use at discharge for the single drug classes, but not for the drug combination. Conclusion Older age and frequent GP visits are associated with decreased use of the guideline-recommended drug combination after AMI. Further research is needed to specify underlying reasons and develop measures to improve persistence.