scholarly journals Beta-blockers and antithrombotic treatment for secondary prevention after acute myocardial infarction Towards an understanding of factors influencing clinical practice

1998 ◽  
Vol 19 (1) ◽  
pp. 74-79 ◽  
Author(s):  
K Woods
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Practice ◽  
Secondary Prevention ◽  
Beta Blockers ◽  
Antithrombotic Treatment ◽  
Factors Influencing

scholarly journals A phenomenological analysis of the experience of taking medication to prevent a further heart attack

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hannah Piekarz ◽  
Catherine Langran ◽  
Parastou Donyai
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Practice ◽  
Secondary Prevention ◽  
Heart Attack ◽  
Interpretative Phenomenological Analysis ◽  
Cardiovascular Events ◽  
Phenomenological Analysis ◽  
Structured Interviews ◽  
Adherence To Medication

AbstractFollowing an acute myocardial infarction, patients are prescribed a regime of cardio-protective medication to prevent recurrent cardiovascular events and mortality. Adherence to medication is poor in this patient group, and not fully understood. Current interventions have made limited improvements but are based upon presumed principles. To describe the phenomenon of medicine-taking for an individual taking medication for secondary prevention for an AMI, Interpretative Phenomenological Analysis was used to analyse transcripts of semi-structured interviews with participants. Themes were generated for each participant, then summarized across participants. Five key themes were produced; the participants needed to compare themselves to others, showed that knowledge of their medicines was important to them, discussed how the future was an unknown entity for them, had assimilated their medicines into their lives, and expressed how an upset to their routine reduced their ability to take medication. Participants described complex factors and personal adaptations to taking their medication. This suggests that a patient-centred approach is appropriate for adherence work, and these themes could inform clinical practice to better support patients in their medicine adherence.

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 Passive Prescription of Secondary Prevention Medical Therapy during Index Hospitalization for Acute Myocardial Infarction Is Prevalent and Associated with Adverse Clinical Outcomes

2021 ◽  
Vol 2021 ◽  
pp. 1-8
Author(s):  
Nancy Xurui Huang ◽  
John E. Sanderson ◽  
Fang Fang ◽  
Cheuk-Man Yu ◽  
Bryan P. Yan
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Multivariate Analysis ◽  
Secondary Prevention ◽  
Clinical Outcomes ◽  
Beta Blocker ◽  
Beta Blockers ◽  
Index Hospitalization ◽  
Prevention Therapy ◽  
Prescription Rates

Secondary prevention therapy reduces death and reinfarction after acute myocardial infarction (AMI), but it is underutilized in clinical practice. Mechanisms for this therapeutic gap are not well established. In this study, we have explored and evaluated the impact of passive continuation compared to active initiation of secondary prevention therapy for AMI during the index hospitalization. For this purpose, we have analyzed 1083 consecutive patients with AMI to a tertiary referral hospital in Hong Kong and assessed discharge prescription rates of secondary prevention therapies (aspirin, beta-blockers, statins, and ACEI/ARBs). Multivariate analysis was used to identify independent predictors of discharge medication, and Kaplan–Meier survival curve was used to evaluate 12-month survival. Overall, prescription rates of aspirin, beta-blocker, statin, and ACEI/ARBs on discharge were 94.8%, 64.5%, 83.5%, and 61.4%, respectively. Multivariate analysis showed that prior use of each therapy 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-blocker (OR = 2.5, 95% CI = 1.8–3.4, P < 0.01 ); statin (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 patients (aspirin (13.7% vs. 5.7%), beta-blockers (12.9% vs. 5.6%), and statins (11.0% vs. 4.6%); all P < 0.01 ). Overall, the use of secondary prevention medication for AMI was suboptimal. Our findings suggested that the practice of passive continuation of prior medication was prevalent and associated with adverse clinical outcomes compared to active initiation of secondary preventive therapies for acute myocardial infarction during the index hospitalization.

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):  
S&oslash;ren Sk&oslash;tt Andersen ◽  
Morten Lock Hansen ◽  
Gunnar H. Gislason ◽  
Fredrik Folke ◽  
Tina Ken Schramm ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Beta Blockers

Abstract 3522: Transfer Patients With Acute Myocardial Infarction Do Not Impact Hospital Quality Measurements, Despite Being Sicker Than Directly Admitted Patients

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Creighton Don ◽  
Douglas Stewart ◽  
Susan Heckbert ◽  
Charles Maynard ◽  
Richard Goss
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blockers ◽  
Artery Bypass ◽  
Coronary Intervention ◽  
Hospital Quality ◽  
Lipid Lowering ◽  
Hospital Death ◽  
Hospital Level ◽  
Risk Of Death

BACKGROUND Studies of hospital quality and national performance measures for acute myocardial infarction (AMI) frequently exclude transfer patients. Little is known about the clinical characteristics and outcomes of patients with AMI transferred for revascularization. HYPOTHESIS Transfer patients have greater clinical comorbidity and worse hospital survival than non-transfer patients, and negatively impact hospital quality measures. METHODS A retrospective-cohort study was performed using all patients with ST-elevation myocardial infarction who underwent coronary intervention or coronary artery bypass grafting (CABG) in Washington State from 2002 – 2005. Data on clinical and procedural characteristics, medications, and complications were obtained from the Clinical Outcomes Assessment Program. Hospitals were compared by rates of death and discharge with aspirin, beta-blockers, lipid lowering agents, and ACE inhibitors. Logistic regression was used for adjusted analysis. RESULTS Of patients undergoing revascularization for AMI, 7080 were directly admitted and 2910 were transferred. Diabetes (23.4 v. 19.7%, p<0.01), hypertension (61.3 v. 55.7%, p<0.01), and thrombolysis (32.3 v. 3.4%, p <0.01) were greater among transfers. Transfers presented with a higher rate of left main and three-vessel disease, intra-aortic balloon pump use (6.4 v. 3.6%, p<0.01) and underwent CABG more frequently (15.4 v. 5.5%, p <0.01). Transfer patients had a lower risk of death (3.9 v. 4.9%, p=0.03), but no difference in discharge medication prescription. Adjusting for major risk factors, procedure, and hospital type, transfers had a similar risk for in-hospital death compared to non-transfers (OR 0.9, CI 0.5 – 1.6). Hospitals with a high percentage of transfers treated higher-risk patients, but had similar outcomes to those with few transfers. Excluding transfers from the hospital-level analysis did not appreciably change these results. CONCLUSION Transfers were higher-risk, but had similar in-hospital mortality and were equally likely to receive appropriate medication at discharge compared to directly admitted patients. Inclusion of transfers did not affect hospital-level inpatient mortality or measurements of adherence to quality guidelines.

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