Jang Hoon Lee1, Myung Hwan Bae1, Dong Heon Yang1, Hun Sik Park1, Yongkeun Cho1, Myung Ho Jeong2, Young Jo Kim3, Kee-Sik Kim4, Seung Ho Hur5, In Whan Seong6, Myeong Chan Cho7, Chong Jin Kim8, Shung Chull Chae1. 1. Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea. 2. Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea. 3. Department of Internal Medicine, Yeungnam University Hospital, Daegu, Republic of Korea. 4. Department of Internal Medicine, Daegu Catholic University Hospital, Daegu, Republic of Korea. 5. Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Republic of Korea. 6. Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Republic of Korea. 7. Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Republic of Korea. 8. Department of Internal Medicine, Kyung Hee University East-west Neo Medical Center, Seoul, Republic of Korea.
Abstract
BACKGROUND: Temporal trends of evidence-based optimal medical therapy (OMT) at discharge after acute myocardial infarction (AMI) have not been investigated in recent years. HYPOTHESIS: OMT should have been increased in AMI and gap between guidelines and practices in its use should have been narrowed. METHODS: We examined discharge medications of 17,578 post-MI patients who had no documented contraindications to antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors, or statins across a 6-year period (divided into subperiods of November 2005 to December 2006 [period 1], 2007 [period 2], 2008 [period 3], 2009 [period 4], 2010 [period 5], and January to June 2011 [period 6]) in the Korean AMI Registry. OMT was defined as use of all 4 indicated medications. RESULTS: Marked increases in OMT (48.6% to 63.2%) were seen irrespective of age and sex, mainly attributed to marked increases in the use of β-blockers (70.3% to 83.7%) and statins (76.9% to 82.6%) from period 1 to period 6. The gap in use of OMT between men and women narrowed over time between the first and second 3 periods, but not between the young and the elderly. Advanced age (odds ratio [OR]: 0.88, P = 0.04) was independently associated with underuse of OMT. Adjusted ORs for OMT from period 1 to period 6 were as follows: 1, 1.14 (P = 0.024), 1.21 (P = 0.001), 1.40 (P < 0.001), 1.47 (P < 0.001), and 1.69 (P < 0.001), respectively. CONCLUSIONS: Despite gradual increase in OMT over time, the gap between guidelines and practices in use of OMT continues to exist.
BACKGROUND: Temporal trends of evidence-based optimal medical therapy (OMT) at discharge after acute myocardial infarction (AMI) have not been investigated in recent years. HYPOTHESIS: OMT should have been increased in AMI and gap between guidelines and practices in its use should have been narrowed. METHODS: We examined discharge medications of 17,578 post-MI patients who had no documented contraindications to antiplatelet agents, β-blockers, angiotensin-converting enzyme inhibitors, or statins across a 6-year period (divided into subperiods of November 2005 to December 2006 [period 1], 2007 [period 2], 2008 [period 3], 2009 [period 4], 2010 [period 5], and January to June 2011 [period 6]) in the Korean AMI Registry. OMT was defined as use of all 4 indicated medications. RESULTS: Marked increases in OMT (48.6% to 63.2%) were seen irrespective of age and sex, mainly attributed to marked increases in the use of β-blockers (70.3% to 83.7%) and statins (76.9% to 82.6%) from period 1 to period 6. The gap in use of OMT between men and women narrowed over time between the first and second 3 periods, but not between the young and the elderly. Advanced age (odds ratio [OR]: 0.88, P = 0.04) was independently associated with underuse of OMT. Adjusted ORs for OMT from period 1 to period 6 were as follows: 1, 1.14 (P = 0.024), 1.21 (P = 0.001), 1.40 (P < 0.001), 1.47 (P < 0.001), and 1.69 (P < 0.001), respectively. CONCLUSIONS: Despite gradual increase in OMT over time, the gap between guidelines and practices in use of OMT continues to exist.