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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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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

Authors
  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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