Abstract 184: Patterns of Outpatient Follow-up after Acute Myocardial Infarction: Follow-up Frequency is Associated with Utilization of Evidence-based Therapies

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Rebecca Vigen ◽  
Yan Li ◽  
Thomas M Maddox ◽  
Stacie Daugherty ◽  
Steven M Bradley ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Primary Outcome ◽  
Beta Blockers ◽  
Primary Care Providers ◽  
Risk Scores ◽  
Evidence Based ◽  
Care Providers ◽  
Multivariable Analyses

Background: ACC/AHA guidelines recommend that patients with acute myocardial infarction (AMI) follow-up within several weeks of hospital discharge. Recommendations regarding intensity of following-up in the year following AMI are not provided. The relationship between frequency of follow-up and use of evidence-based therapies following AMI is unknown. Methods: 6,838 patients from 2 multicenter prospective AMI registries, PREMIER and TRIUMPH registries were studied. We divided the number of patient self-reported outpatient follow-up visits with cardiologists, primary care providers, or both into tertiles: low, medium, and high. The primary outcome was use of statins, beta blockers, aspirin, ACE/ARBs, and a composite of all four medications at 12 months among eligible patients. The association between tertiles of visits following AMI among patients who had at least one visit and primary outcome was evaluated using hierarchical multivariable modified Poisson models. Results: Mean number of follow-up visits in the year following AMI was 6 (IQR 3 - 8) and 189 (4%) of patients had no visits. In lowest tertile, patients had 1 to < 4 visits, in the medium tertile, 4 to < 7 visits, and in highest tertile, 7 to 59 visits. Patients in medium and high intensity tertiles were older, more likely to have insurance, and had higher GRACE 6-month mortality risk scores compared to the lowest tertile. In multivariable analyses, patients in the medium tertile were more likely to use statins and ASA than those in the lowest tertile (Figure). There were no differences in use of individual medications when comparing the highest and medium tertiles although individuals in the highest tertile were less likely to use all four medications. Conclusions: Significant variability exists in follow-up frequency following AMI and 4% of the cohort had no follow-up. Patients who had medium intensity visits were more likely to use some evidence-based medications than those with low intensity. Higher intensity visits was not associated with greater medication use. It is possible that the observed differences may be attributed to unmeasured differences among patients rather than the actual follow-up visits. Prospective studies are needed to assess key elements of outpatient visits that may lead to better utilization of evidence-based therapies.

P6424The association between long-term beta-blocker use and outcome in a contemporary large-scale cohort of patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
C X Song ◽  
R Fu ◽  
J G Yang ◽  
K F Dou ◽  
Y J Yang
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Beta Blocker ◽  
Cardiovascular Events ◽  
Beta Blockers ◽  
Left Ventricular Ejection ◽  
Major Adverse Cardiovascular Events ◽  
Baseline Characteristics

Abstract Background Controversy exists regarding the use of beta-blockers (BBs) among patients with acute myocardial infarction (AMI) in contemporary reperfusion era. Previous studies predominantly focused on beta-blockers prescribed at discharge, and the effect of long-term adherence to beta-blocker on major adverse cardiovascular events (MACE) remains unclear. Objective To explore the association between long-term beta-blocker use patterns and MACE among contemporary AMI patients. Methods We enrolled 7860 patients with AMI, who were discharged alive and prescribed with BBs based on CAMI registry from January 2013 to September 2014. Patients were divided into two groups according to BBs use pattern: Always users group (n=4476) were defined as patients reporting BBs use at both 6- and 12-month follow-up; Inconsistent users group were defined as patients reporting at least once not using BBs at 6- or 12-month follow-up. Primary outcome was defined as MACE at 24-month follow-up, including all-cause death, non-fatal MI and repeat-revascularization. Multivariable cox proportional hazards regression model was used to assess the association between BBs and MACE. Results Baseline characteristics are shown in table 1. At 2-year follow-up, 518 patients in inconsistent users group (15.6%) and 548 patients in always users group (12.3%) had MACE. After multivariable adjustment, inconsistent use of BBs was associated with higher risk of MACE (HR: 1.323, 95% CI: 1.171–1.493, p<0.001). Table 1 Baseline characteristics Variable Always user (N=4476) Inconsistent user (N=3384) P value Age (years) 60.6±12.0 61.2±12.2 <0.001 Male 3381 (75.7%) 2461 (74.3%) 0.084 Diabetes 892 (20.0%) 610 (18.4%) 0.003 Hypertension 2372 (53.2%) 1543 (46.6%) <0.001 Dyslipidemia 244 (5.5%) 126 (3.8%) <0.001 Prior myocardial infarction 351 (7.9%) 232 (7.0%) <0.001 Heart failure 88 (2.0%) 63 (1.9%) <0.001 Chronic obstructive pulmonary disease 66 (1.5%) 60 (1.8%) <0.001 Current smoker 2054 (46.1%) 1579 (47.8%) 0.179 Left ventricular ejection fraction (%) 53.7±11.48 54.0±10.9 <0.001 Major Adverse Cardiovascular Events 548 (12.3%) 518 (15.6%) <0.001 Conclusions Our results showed consistent BBs use was associated with reduced risk of MACE among patients with AMI managed by contemporary treatment. Acknowledgement/Funding CAMS Innovation Fund for Medical Sciences (CIFMS) (2016-I2M-1-009)

Abstract 332: Persistent Use Of Evidence-Based Medications After Discharge Among Patients With Non-ST Elevation Myocardial Infarction Treated At Academic Versus Non-Academic Hospitals

2013 ◽  
Vol 6 (suppl_1) ◽  
Author(s):  
Jennifer Rymer ◽  
Lisa McCoy ◽  
Laine Thomas ◽  
Eric Peterson ◽  
Tracy Wang
Keyword(s):  
Myocardial Infarction ◽  
Beta Blockers ◽  
St Elevation Myocardial Infarction ◽  
Hospital Treatment ◽  
Evidence Based ◽  
Post Discharge ◽  
Academic Hospitals ◽  
St Elevation ◽  
And Gender

Background: While academic hospitals are more likely to apply evidence-based therapies in-hospital for patients with non-ST elevation myocardial infarction (NSTEMI) than non-academic hospitals, differences in post-discharge persistence of evidence-based medications have never been evaluated. Methods: We examined 3,184 NSTEMI patients over age 65 treated at 250 hospitals in 2006 in the CRUSADE registry linked to Medicare part D pharmacy data. Using multivariable Poisson regression adjusting for case mix, we compared continued filling of prescriptions for beta-blockers, ACEI/ARB, clopidogrel, and statins at 90 days and 1 year post-discharge between patients treated at academic and non-academic hospitals. Results: Patients treated at academic hospitals were more frequently non-white (19% vs. 8%, p<0.001), but age (median 76 years) and gender (53% female) were not significantly different from patients treated at non-academic hospitals. Patients at academic hospitals were more likely to have a Charlson score >4 (36% vs. 30%, p=0.001), yet the rates of in-hospital PCI (48%) and CABG (8%) were similar between groups. Rates of persistence to evidence-based medications did not differ substantially between patients treated at academic vs. non-academic hospitals at 90 days or 1 year (Table). Persistence to all drug classes prescribed at discharge was low and not significantly different between academic and non-academic hospitals at 90 days (46% vs. 45%, p=0.44 with adjusted incidence rate ratio (IRR)=0.99 (0.95,1.04) and at 1-year (39% vs. 39%, p=0.93, adjusted IRR=1.02 (0.98,1.07)). There were no significant differences in index hospitalization duration (median 4 days, interquartile range (IQR) 3-6 for both, p=0.51) and time to first post-discharge cardiac follow-up visit (median 28 days [IQR 15-54] vs. 28 days [IQR 16-56], p=0.25) between patients treated at academic vs. non-academic hospitals. Conclusion: Rates of persistence to evidence-based medications were similar between older NSTEMI patients treated at academic vs. non-academic hospitals, and may reflect similar in-hospital treatment and post-discharge cardiac follow-up. However, persistence rates are low both early and late post-discharge, highlighting a continued need for quality improvement efforts to optimize post-MI management.

scholarly journals Untapped Possibilities of Antiischemic Therapy after Acute Myocardial Infarction: Data from the PROFILE-IM Register

2020 ◽  
Vol 16 (5) ◽  
pp. 798-803
Author(s):  
E. P. Kalaydzhyan ◽  
S. Yu. Martsevich ◽  
N. P. Kutishenko ◽  
D. P. Sichinava ◽  
O. M. Drapkina
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Angina Pectoris ◽  
Beta Blockers ◽  
Clinical Manifestations ◽  
First Year ◽  
Evidence Based ◽  
Long Acting ◽  
Almost All ◽  
Based Medicine

Aim. To evaluate the practice of prescribing antianginal/antiischemic therapy in patients who, after acute myocardial infarction (AMI), retained typical clinical manifestations of stable angina.Material and methods. The registry includes 160 patients who applied to the polyclinic from March 01, 2014 to June 30, 2015 after suffering an AMI. Anti-ischemic therapy was evaluated in patients with typical angina pectoris.Results. Based on the survey, typical angina attacks were detected in almost a quarter of patients (38 patients – 23.8%). According to the main indicators, patients with typical angina pectoris practically did not differ from the rest of the group of patients, with the exception of a significantly larger proportion of patients with diagnosed ischemic heart disease before AMI and patients under dispensary supervision. Almost all patients received beta-blockers (97.4%), about a third of patients received calcium antagonists (28.9%) or long-acting nitrates (34,2%). During the first year after AMI, second-line drugs were practically not prescribed to enhance antianginal therapy. According to international non-proprietary names, the choice of doctors tended to prescribe bisoprolol, amlodipine, and isosorbide dinitrate. Exacerbation of the disease course with hospitalization for unstable angina pectoris was recorded in 9 (23.7%) patients from the group with typical angina pectoris and in 5 (4.1%) patients in the rest of the group (p<0.001).Conclusion. In real clinical practice, only a small part of patients with typical angina pectoris receive drug therapy that corresponds to evidence-based medicine; therefore, the unique possibilities of antianginal (anti-ischemic) therapy often remain unrealized.

P628Association of outpatient cardiac rehabilitation with mortality and morbidities in patients with acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Seki ◽  
M Takeuchi ◽  
S Kawasoe ◽  
K Takeuchi ◽  
R Miki ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Acute Myocardial Infarction ◽  
Percutaneous Coronary Intervention ◽  
Clinical Practice ◽  
Survival Benefit ◽  
Primary Outcome ◽  
Coronary Intervention ◽  
Percutaneous Coronary

Abstract Background/Introduction Outpatient cardiac rehabilitation (CR) is commonly recommended for patients with acute myocardial infarction (AMI). However, the survival benefit has recently been contested, especially with no survival benefit having been found in non-Western countries. Purpose To investigate whether outpatient CR, under current real-world clinical practice, is associated with lower mortality and morbidity risks in patients with AMI. Methods The retrospective cohort study was conducted from January 2011 to June 2016 (final date of follow-up: July 31, 2016) with a nation-wide administrative database for acute-care hospitals in Japan. Data for 7,411 patients were analyzed, with 5,654 fulfilling the inclusion criteria of being admitted for AMI and receiving both percutaneous coronary intervention and inpatient CR between January 2011 and December 2014. We compared patients who participated in outpatient CR at least once within 180 days of discharge and who did not. To account for measured baseline imbalances between outpatient CR participants and non-participants, 1:1 propensity-score matching was performed. The primary outcome was a composite of all-cause death and recurrence of AMI after the landmark time-point of day 180 after discharge. Secondary outcomes included all-cause death, recurrence of AMI, and heart failure. Results Among 5,654 patients (mean [SD] age, 66.8 [12.4] years; 21.2% female; median follow-up period [IQR] 1.44 [0.87 to 2.27] years), 730 (12.9%) received outpatient CR. Of 1,458 propensity-score matched patients, outpatient CR participants did not show a significantly lower risk of the primary outcome than non-participants (1.38 vs. 2.12 per 100 patient-years; hazard ratio [HR], 0.71 [95% CI, 0.32 to 1.61]). Similarly, outpatient CR participation was not associated with lower risks of all-cause death (0.68 vs. 1.31 per 100 patient-years; HR, 0.83 [95% CI, 0.25 to 2.73]), recurrence of AMI (0.69 vs. 0.88 per 100 patient-years; HR, 0.56 [95% CI, 0.19 to 1.66]) or heart failure (2.01 vs. 2.06 per 100 patient-years; HR, 0.89 [95% CI, 0.47 to 1.72]), respectively. Conclusion Among patients with AMI who received percutaneous coronary intervention and inpatient CR, outpatient CR was not associated with lower risks of mortality and morbidities. The survival benefit of outpatient CR should be reaffirmed under current real-world clinical practice, especially in non-Western countries.

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