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

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Abstract

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 ≥75 years (odds ratio [OR] 0.49; 95 % confidence interval [CI] 0.29–0.85) and ten or more visits with general practitioners (GPs) over 1 year (OR 0.29; 95 % CI 0.17–0.51). 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.

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References

  1. Roger VL, Go AS, Lloyd-Jones DM, et al. Heart disease and stroke statistics—2011 update: a report from the American Heart Association. Circulation. 2011;123(4):e18–209. doi:10.1161/CIR.0b013e3182009701.

    Article  PubMed  Google Scholar 

  2. Allender S, Scarborough P, Peto V, Rayner M, Leal J, Luengo-Fernandez R, Gray A. European cardiovascular disease statistics: 2008 edition. Oxford: Department of Public Health, University of Oxford; 2008 [online]. Available from: http://www.herzstiftung.ch/uploads/media/European_cardiovascular_disease_statistics_2008.pdf.

  3. Bonaca MP, Wiviott SD, Braunwald E, Murphy SA, Ruff CT, Antman EM, Morrow DA. American College of Cardiology/American Heart Association/European Society of Cardiology/World Heart Federation universal definition of myocardial infarction classification system and the risk of cardiovascular death: observations from the TRITON-TIMI 38 trial (trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-thrombolysis in myocardial infarction 38). Circulation. 2012;125(4):577–83. doi:10.1161/CIRCULATIONAHA.111.041160.

    Article  PubMed  Google Scholar 

  4. Freemantle N, Cleland J, Young P, Mason J, Harrison J. Beta blockade after myocardial infarction: systematic review and meta regression analysis. BMJ. 1999;318(7200):1730–7.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  5. Bramlage P, Messer C, Bitterlich N, Pohlmann C, Cuneo A, Stammwitz E, Tebbenjohanns J, Gohlke H, Senges J, Tebbe U. The effect of optimal medical therapy on 1-year mortality after acute myocardial infarction. Heart. 2010;96(8):604–9. doi:10.1136/hrt.2009.188607.

    Article  CAS  PubMed  Google Scholar 

  6. Tuppin P, Neumann A, Danchin N, de Peretti C, Weill A, Ricordeau P, Allemand H. Evidence-based pharmacotherapy after myocardial infarction in France: adherence-associated factors and relationship with 30-month mortality and rehospitalization. Arch Cardiovasc Dis. 2010;103(6–7):363–75 (S1875-2136(10)00114-2).

    Article  PubMed  Google Scholar 

  7. van der Elst ME, Bouvy ML, de Blaey CJ, de Boer A. Effect of drug combinations on admission for recurrent myocardial infarction. Heart. 2007;93(10):1226–30 (epub 13 May 2007).

    Article  PubMed Central  PubMed  Google Scholar 

  8. Choudhry NK, Avorn J, Glynn RJ, Antman EM, Schneeweiss S, Toscano M, Reisman L, Fernandes J, Spettell C, Lee JL, Levin R, Brennan T, Shrank WH. Full coverage for preventive medications after myocardial infarction. N Engl J Med. 2011;365(22):2088–97. doi:10.1056/NEJMsa1107913.

    Article  CAS  PubMed  Google Scholar 

  9. Anderson JL, Adams CD, Antman EM, et al. ACC/AHA 2007 guidelines for the management of patients with unstable angina/non ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 2002 Guidelines for the Management of Patients With Unstable Angina/Non ST-Elevation Myocardial Infarction): developed in collaboration with the American College of Emergency Physicians, the Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons: endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation and the Society for Academic Emergency Medicine. Circulation. 2007;116(7):e148–304. doi:10.1161/CIRCULATIONAHA.107.181940.

    Article  PubMed  Google Scholar 

  10. Bassand JP, Hamm CW, Ardissino D, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. The Task Force for the Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of the European Society of Cardiology. Eur Heart J. 2007;28:1598–660.

    Article  CAS  PubMed  Google Scholar 

  11. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG, Tubaro M, Verheugt F, Weidinger F, Weis M. ESC guidelines on management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Rev Esp Cardiol. 2009;62(3):293 (e291–247, pii 13133305).

    Google Scholar 

  12. Antman EM, Hand M, Armstrong PW, et al. 2007 Focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration With the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee. Circulation. 2008;117(2):296–329. doi:10.1161/CIRCULATIONAHA.107.188209.

    Article  PubMed  Google Scholar 

  13. Vedin O, Hagström E, Stewart R, Brown R, Krug-Gourley S, Davies R, Wallentin L, White H, Held C. Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary heart disease: baseline results from the STABILITY study. Eur J Prev Cardiol. 2013;20(4):678–85.

  14. Kotseva K, Wood D, De Backer G, De Bacquer D, Pyorala K, Keil U. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009;16(2):121–37. doi:10.1097/HJR.0b013e3283294b1d.

    Article  PubMed  Google Scholar 

  15. Simpson E, Beck C, Richard H, Eisenberg MJ, Pilote L. Drug prescriptions after acute myocardial infarction: dosage, compliance, and persistence. Am Heart J. 2003;145:438–44.

    Article  PubMed  Google Scholar 

  16. Mangiapane S, Busse R. Prescription prevalence and continuing medication use for secondary prevention after myocardial infarction: the reality of care revealed by claims data analysis. Dtsch Arztebl Int. 2011;108(50):856–62. doi:10.3238/arztebl.2011.0856.

    PubMed Central  PubMed  Google Scholar 

  17. Kirchmayer U, Agabiti N, Belleudi V, Davoli M, Fusco D, Stafoggia M, Arca M, Barone AP, Perucci CA. Socio-demographic differences in adherence to evidence-based drug therapy after hospital discharge from acute myocardial infarction: a population-based cohort study in Rome, Italy. J Clin Pharm Ther. 2012;37(1):37–44. doi:10.1111/j.1365-2710.2010.01242.x.

    Article  CAS  PubMed  Google Scholar 

  18. Sirois C, Moisan J, Poirier P, Gregoire JP. Underuse of cardioprotective treatment by the elderly with type 2 diabetes. Diabetes Metab. 2008;34(2):169–76. doi:10.1016/S1262-3636(08)00039-6.

    Article  CAS  PubMed  Google Scholar 

  19. Kirchberger I, Meisinger C, Seidl H, Wende R, Kuch B, Holle R. Nurse-based case management for aged patients with myocardial infarction: study protocol of a randomized controlled trial. BMC Geriatr. 2010;10:29 (pii 1471-2318-10-29).

    Article  PubMed Central  PubMed  Google Scholar 

  20. Meisinger C, Stollenwerk B, Kirchberger I, Seidl H, Wende R, Kuch B, Holle R. Effects of a nurse-based case management compared to usual care among aged patients with myocardial infarction: results from the randomized controlled KORINNA study. BMC Geriatr. 2013;13(1):115.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med. 1999;130(6):461–70 (pii 199903160-00002).

    Article  CAS  PubMed  Google Scholar 

  22. Kuch B, von Scheidt W, Kling B, Heier M, Hoermann A, Meisinger C. Characteristics and outcome of patients with acute myocardial infarction according to presenting electrocardiogram (from the MONICA/KORA Augsburg Myocardial Infarction—Registry). Am J Cardiol. 2007;100(7):1056–60 (pii S0002-9149(07)01246-5).

    Article  PubMed  Google Scholar 

  23. Sheikh JI, Yesavage JA. A knowledge assessment test for geriatric psychiatry. Hosp Community Psychiatry. 1985;36:1160–6.

    CAS  PubMed  Google Scholar 

  24. Cramer J, Roy A, Burrell A, Menown I, Kassianos G, Padmanabhan S, Gupta S, Lang CC. Medication compliance and persistence: terminology and definitions. Value Health. 2008;11(1):44–7.

    Article  PubMed  Google Scholar 

  25. Gislason GH, Rasmussen JN, Abildstrøm SZ, Gadsbøll N, Buch P, Friberg J, Rasmussen S, Køber L, Stender S, Madsen M, Torp-Pedersen C. Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction. Eur Heart J. 2006;27(10):1153–8 (epub 6 Jan 2006).

    Article  CAS  PubMed  Google Scholar 

  26. Kalra PR, Morley C, Barnes S, Menown I, Kassianos G, Padmanabhan S, Gupta S, Lang CC. Discontinuation of beta-blockers in cardiovascular disease: UK primary care cohort study. Int J Cardiol. 2012. doi:10.1016/j.ijcard.2012.06.116.

    Google Scholar 

  27. Anatomisch-therapeutisch-chemische Klassifikation (ATC). Wissenschaftliches Institut der AOK. http://www.wido.de/arz_atcddd-klassifi.html. Accessed 27 May 2013.

  28. Allison PD. Logistic regression using the SAS system: theory and application. Cary: SAS Institute; 1999.

    Google Scholar 

  29. Bischoff B, Silber S, Richartz BM, Pieper L, Klotsche J, Wittchen HU, DETECT Study-Group. Inadequate medical treatment of patients with coronary artery disease by primary care physicians in Germany. Clin Res Cardiol. 2006;95(8):405–12 (epub 3 Jul 2006).

    Article  CAS  PubMed  Google Scholar 

  30. Bauer T, Gitt AK, Junger C, Zahn R, Koeth O, Towae F, Schwarz AK, Bestehorn K, Senges J, Zeymer U. Guideline-recommended secondary prevention drug therapy after acute myocardial infarction: predictors and outcomes of nonadherence. Eur J Cardiovasc Prev Rehabil. 2010;17(5):576–81. doi:10.1097/HJR.0b013e328338e5da.

    Article  PubMed  Google Scholar 

  31. Meisinger C, Heier M, von Scheidt W, Kirchberger I, Hormann A, Kuch B. Gender-specific short and long-term mortality in diabetic versus nondiabetic patients with incident acute myocardial infarction in the reperfusion era (the MONICA/KORA Myocardial Infarction Registry). Am J Cardiol. 2010;106(12):1680–4 (pii S0002-9149(10)01610-3).

    Article  PubMed  Google Scholar 

  32. Kuepper-Nybelen J, Hellmich M, Abbas S, Ihle P, Griebenow R, Schubert I. Association of long-term adherence to evidence-based combination drug therapy after acute myocardial infarction with all-cause mortality. A prospective cohort study based on claims data. Eur J Clin Pharmacol. 2012;68(10):1451–60. doi:10.1007/s00228-012-1274-x.

    Article  CAS  PubMed  Google Scholar 

  33. Spencer FA, Lessard D, Yarzebski J, Gore JM, Goldberg RJ. Decade-long changes in the use of combination evidence-based medical therapy at discharge for patients surviving acute myocardial infarction. Am Heart J. 2005;150(4):838–44 (pii S0002-8703(04)00814-2).

    Article  PubMed  Google Scholar 

  34. Gislason GH, Abildstrom SZ, Rasmussen JN, Rasmussen S, Buch P, Gustafsson I, Friberg J, Gadsbøll N, Køber L, Stender S, Madsen M, Torp-Pedersen C. Nationwide trends in the prescription of beta-blockers and angiotensin-converting enzyme inhibitors after myocardial infarction in Denmark, 1995–2002. Scand Cardiovasc J. 2005;39(1–2):42–9.

    Article  PubMed  Google Scholar 

  35. Boggon R, van Staa TP, Timmis A, Hemingway H, Ray KK, Begg A, Emmas C, Fox KA. Clopidogrel discontinuation after acute coronary syndromes: frequency, predictors and associations with death and myocardial infarction—a hospital registry-primary care linked cohort (MINAP-GPRD). Eur Heart J. 2011;32(19):2376–86 (pii ehr340).

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  36. Macchia A, Romero M, D’Ettorre A, Mariani J, Tognoni G. Temporal trends of the gaps in post-myocardial infarction secondary prevention strategies of co-morbid and elderly populations vs. younger counterparts: an analysis of three successive cohorts between 2003 and 2008. Eur Heart J. 2012;33(4):515–22 (pii ehr410).

    Article  PubMed  Google Scholar 

  37. Newby LK, LaPointe NM, Chen AY, Kramer JM, Hammill BG, DeLong ER, Muhlbaier LH, Califf RM. Long-term adherence to evidence-based secondary prevention therapies in coronary artery disease. Circulation. 2006;113(2):203–12. doi:10.1161/CIRCULATIONAHA.105.505636 (epub 9 Jan 2006).

    Article  CAS  PubMed  Google Scholar 

  38. Soumerai SB, McLaughlin TJ, Spiegelman D, Hertzmark E, Thibault G, Goldman L. Adverse outcomes of underuse of beta-blockers in elderly survivors of acute myocardial infarction. JAMA. 1997;277:115–21.

    Article  CAS  PubMed  Google Scholar 

  39. Setoguchi S, Glynn RJ, Avorn J, Mittleman MA, Levin R, Winkelmayer WC. Improvements in long-term mortality after myocardial infarction and increased use of cardiovascular drugs after discharge: a 10-year trend analysis. J Am Coll Cardiol. 2008;51(13):1247–54. doi:10.1016/S0735-1097(08)00229-5.

    Article  PubMed  Google Scholar 

  40. Aronow WS. Beta-blockers, angiotensin-converting enzyme inhibitors, and calcium antagonists in treatment of elderly patients with acute myocardial infarction. Coron Artery Dis. 2000;11(4):331–8.

    Article  CAS  PubMed  Google Scholar 

  41. Scherrer JF, Chrusciel T, Garfield LD, Freedland KE, Carney RM, Hauptman PJ, Bucholz KK, Owen R, Lustman PJ. Treatment-resistant and insufficiently treated depression and all-cause mortality following myocardial infarction. Br J Psychiatry. 2012;200(2):137–42. doi:10.1192/bjp.bp.111.096479 (epub 12 Jan 2012).

    Article  PubMed  Google Scholar 

  42. Daugherty SL, Ho PM, Spertus JA, Jones PG, Bach RG, Krumholz HM, Peterson ED, Rumsfeld JS, Masoudi FA. Association of early follow-up after acute myocardial infarction with higher rates of medication use. Arch Intern Med. 2008;168(5):485–91 (discussion 492; pii 168/5/485).

    Article  PubMed  Google Scholar 

  43. Clark A. Ageism and age discrimination in primary and community health care in the United Kingdom. A review from the literature. Department of Health, Centre for Policy on Ageing; 2009: 1–90, p 17. http://www.cpa.org.uk/information/reviews/CPA-ageism_and_age_discrimination_in_primary_and_community_health_care-report.pdf. Accessed 27 May 2013.

  44. Col N, Fanale JE, Kronholm P. The role of medication noncompliance and adverse drug reactions in hospitalizations of the elderly. Arch Intern Med. 1990;150(4):841–5.

    Article  CAS  PubMed  Google Scholar 

  45. Austin PC, Tu JV, Ko DT, Alter DA. Factors associated with the use of evidence-based therapies after discharge among elderly patients with myocardial infarction. CMAJ. 2008;179(9):901–8 (pii 179/9/901).

    Article  PubMed Central  PubMed  Google Scholar 

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Acknowledgments

The present trial is conducted within subproject 2 of the research cooperation KORA-Age and is funded by the German Federal Ministry of Education and Research (01 ET 0703). The KORA research platform is financed by the Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), which is funded by the German Federal Ministry of Education, Science, Research and Technology and by the State of Bavaria.

The authors thank all members of the Helmholtz Zentrum München who are involved in the conduct of the study. Furthermore, we wish to thank the field staff in Augsburg and Dr. Margit Heier for her support regarding the medication data management. Finally, we express our appreciation to all study participants.

Conflict of interest

All of the authors declare having no conflicts of interest that are relevant to the content of this study.

Author information

Authors and Affiliations

  1. Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany

    Saba Al-Khadra, Christa Meisinger, Ute Amann & Inge Kirchberger

  2. Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany

    Saba Al-Khadra, Christa Meisinger, Ute Amann & Inge Kirchberger

  3. Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany

    Rolf Holle & Hildegard Seidl

  4. Department of Internal Medicine/Cardiology, Hospital of Nördlingen, Nördlingen, Germany

    Bernhard Kuch

  5. Department of Internal Medicine I, Cardiology, Central Hospital of Augsburg, Augsburg, Germany

    Bernhard Kuch

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  1. Saba Al-Khadra
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  2. Christa Meisinger
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  3. Ute Amann
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  4. Rolf Holle
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  5. Bernhard Kuch
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  6. Hildegard Seidl
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  7. Inge Kirchberger
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Corresponding author

Correspondence to Inge Kirchberger.

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Al-Khadra, S., Meisinger, C., Amann, U. et al. Secondary Prevention Medication After Myocardial Infarction: Persistence in Elderly People over the Course of 1 Year. Drugs Aging 31, 513–525 (2014). https://doi.org/10.1007/s40266-014-0189-x

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