Long-Term Quality of Prescription for ST-Segment Elevation Myocardial Infarction (STEMI) Patients: A Real World 1-Year Follow-Up Study

Christel Bruggmann, Juan F Iglesias, Marianne Gex-Fabry, Rachel Fesselet, Pierre Vogt, Farshid Sadeghipour, Pierre Voirol, Christel Bruggmann, Juan F Iglesias, Marianne Gex-Fabry, Rachel Fesselet, Pierre Vogt, Farshid Sadeghipour, Pierre Voirol

Abstract

Aim: American and European associations of cardiology published specific guidelines about recommended drugs for secondary prevention in ST-segment elevation myocardial infarction (STEMI) patients. Our aim was to assess whether drug prescription for STEMI patients was in accordance with the guidelines at discharge and after 1 year.

Method: We used data of 361 patients admitted for STEMI in a tertiary hospital in Switzerland from 2014 to 2016. We assessed the adequacy of prescription of recommended drugs at two time points: discharge and after 1 year. Medications assessed were aspirin, P2Y12 inhibitors, statin, angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) and β-blockers. We took into account several criteria like statin dosage (low versus high intensity) and presence of contraindication for consideration of optimal therapy. Predictors of incomplete prescription of guideline medications were then assessed with multivariate logistic regression models.

Results: From discharge (n = 358) to 1-year follow-up (n = 303), rate of optimal prescription was reduced from 98.6 to 91.7% for aspirin, from 93.9 to 79.1% for P2Y12 inhibitors, from 83.8 to 65.7% for statins, from 98.6 to 95.6% for ACEIs/ARBs, and from 97.1 to 96.9% for β-blockers. Predictors of incomplete prescription of guideline medications at discharge were female sex (odds ratio [OR] 2.54, p = 0.007), active or former smoker status (OR 2.29, p = 0.017), multivessel disease (OR 2.07, p = 0.022), left ventricular ejection fraction < 40% (OR 2.49, p = 0.008), and transfer to cardiac surgery (OR 9.66, p = 0.018). At 1 year, age > 65 (OR 1.92, p = 0.036) remained the only significant predictor.

Conclusion: The present study showed a high prescription rate of guideline-recommended medications in a referral center for primary percutaneous coronary intervention. At discharge, women and co-morbid patients were at the highest risk of incomplete prescription of guideline medications, whereas long-term prescription was suboptimal for elderly. A drug lacking at time of discharge was rarely introduced within the year, which underscores the paramount importance of optimal prescription at time of discharge. Strategies like implementing a standardized prescription could reduce the proportion of suboptimal prescription. It could therefore be one way to improve the long-term quality of care of our patients to the highest level. This study used local data from AMIS Plus-National Registry of Acute Myocardial Infarction in Switzerland (NCT01305785).

Conflict of interest statement

All authors have completed the International Committee of Medical Journal Editors (ICMJE) Form for Disclosure of Potential Conflicts of Interest. Christel Bruggmann, Juan Fernando Iglesias, Rachel Fesselet, Marianne Gex-Fabry, Farshid Sadeghipour, Pierre Vogt and Pierre Voirol declare that they have no potential conflicts of interest that might be relevant to the contents of this article.

Figures

Fig. 1
Fig. 1
Flow-chart of patients included from April 15, 2014 through April 15, 2016. STEMI ST-segment elevation myocardial infarction
Fig. 2
Fig. 2
Rate of optimal prescription at discharge for each drug class (n = 358 for aspirin, P2Y12 inhibitor and high-intensity statin; n = 349 for ACEI/ARB; n = 347 for BB) and at 1 year (n = 303 for aspirin and statin; n = 282 for P2Y12; n = 297 for ACEI/ARB; n = 295 for BB). ACEI angiotensin-converting-enzyme inhibitor, ARB angiotensin receptor blocker, BB β-blocker, LVEF left ventricular ejection fraction
Fig. 3
Fig. 3
Prescription rate of ACEI/ARB and BB at discharge and at 1 year, according to patient’s LVEF after STEMI. Eleven patients with unknown LVEF at discharge and eight at 1 year. ACEI angiotensin-converting-enzyme inhibitor, ARB angiotensin receptor blocker, BB β-blocker, LVEF left ventricular ejection fraction, STEMI ST-segment elevation myocardial infarction

References

    1. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35(42):2929. doi: 10.1093/eurheartj/ehu378.
    1. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al. Heart disease and stroke statistics-2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67–e492. doi: 10.1161/CIR.0000000000000558.
    1. Hasdai D, Behar S, Wallentin L, Danchin N, Gitt AK, Boersma E, et al. A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS) Eur Heart J. 2002;23(15):1190–1201. doi: 10.1053/euhj.2002.3193.
    1. Roe MT, Messenger JC, Weintraub WS, Cannon CP, Fonarow GC, Dai D, et al. Treatments, trends, and outcomes of acute myocardial infarction and percutaneous coronary intervention. J Am Coll Cardiol. 2010;56(4):254–263. doi: 10.1016/j.jacc.2010.05.008.
    1. Yan AT, Tan M, Fitchett D, Chow CM, Fowlis RA, McAvinue TG, et al. One-year outcome of patients after acute coronary syndromes (from the Canadian Acute Coronary Syndromes Registry) Am J Cardiol. 2004;94(1):25–29. doi: 10.1016/j.amjcard.2004.03.024.
    1. Mukherjee D, Fang J, Chetcuti S, Moscucci M, Kline-Rogers E, Eagle KA. Impact of combination evidence-based medical therapy on mortality in patients with acute coronary syndromes. Circulation. 2004;109(6):745–749. doi: 10.1161/01.CIR.0000112577.69066.CB.
    1. Ho PM, Spertus JA, Masoudi FA, Reid KJ, Peterson ED, Magid DJ, et al. Impact of medication therapy discontinuation on mortality after myocardial infarction. Arch Intern Med. 2006;166(17):1842–1847. doi: 10.1001/archinte.166.17.1842.
    1. Kolh P, Windecker S, Alfonso F, Collet JP, Cremer J, Falk V, et al. ESC/EACTS Guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI) Eur J Cardio-thorac Surg. 2014;46(4):517–592. doi: 10.1093/ejcts/ezu366.
    1. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):529–555. doi: 10.1161/CIR.0b013e3182742c84.
    1. Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: the Task Force for the Management of Acute Coronary Syndromes (ACS) in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC) Eur Heart J. 2011;32(23):2999–3054. doi: 10.1093/eurheartj/ehr236.
    1. Smith SC, Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation endorsed by the World Heart Federation and the Preventive Cardiovascular Nurses Association. J Am Coll Cardiol. 2011;58(23):2432–2446. doi: 10.1016/j.jacc.2011.10.824.
    1. Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the Management of Acute Myocardial Infarction in Patients Presenting with ST-Segment Elevation of the European Society of Cardiology (ESC) Eur Heart J. 2018;39(2):119–177. doi: 10.1093/eurheartj/ehx393.
    1. Tomasevic D, El Khoury C, Subtil F, Dubien PY, Bochaton T, Serre P, et al. Effect of optimal medical therapy at discharge in patients with reperfused ST-segment elevation myocardial infarction on 1-year mortality (from the Regional RESCUe Registry) Am J Cardiol. 2018;121(4):403–409. doi: 10.1016/j.amjcard.2017.11.002.
    1. Auer R, Gencer B, Raber L, Klingenberg R, Carballo S, Carballo D, et al. Quality of care after acute coronary syndromes in a prospective cohort with reasons for non-prescription of recommended medications. PLoS One. 2014;9(3):e93147. doi: 10.1371/journal.pone.0093147.
    1. Welker J, Auer R, Gencer B, Muller O, Cornuz J, Matter CM, et al. Hospital revascularisation capability and quality of care after an acute coronary syndrome in Switzerland. Swiss Med Wkly. 2016;146:w14275. doi: 10.4414/smw.2016.14275.
    1. Gencer B, Rodondi N, Auer R, Raber L, Klingenberg R, Nanchen D, et al. Reasons for discontinuation of recommended therapies according to the patients after acute coronary syndromes. Eur J Intern Med. 2015;26(1):56–62. doi: 10.1016/j.ejim.2014.12.014.
    1. Jneid H, Addison D, Bhatt DL, Fonarow GC, Gokak S, Grady KL, et al. 2017 AHA/ACC clinical performance and quality measures for adults with ST-elevation and non-ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes. 2017 doi: 10.1161/hcq.0000000000000032.
    1. Schiele F, Gale CP, Bonnefoy E, Capuano F, Claeys MJ, Danchin N, et al. Quality indicators for acute myocardial infarction: a position paper of the Acute Cardiovascular Care Association. Eur Heart J Acute Cardiovasc Care. 2017;6(1):34–59. doi: 10.1177/2048872616643053.
    1. Summary of recommendation statements Kidney Int Suppl. 2012;2(1):8–12. doi: 10.1038/kisup.2012.7.
    1. Hoedemaker NPG, Damman P, Ottervanger JP, Dambrink JHE, Gosselink ATM, Kedhi E, et al. Trends in optimal medical therapy prescription and mortality after admission for acute coronary syndrome: a 9-year experience in a real-world setting. Eur Heart J Cardiovasc Pharmacother. 2018;4(2):102–110. doi: 10.1093/ehjcvp/pvy005.
    1. Chen HY, Saczynski JS, Lapane KL, Kiefe CI, Goldberg RJ. Adherence to evidence-based secondary prevention pharmacotherapy in patients after an acute coronary syndrome: a systematic review. Heart Lung J Crit Care. 2015;44(4):299–308. doi: 10.1016/j.hrtlng.2015.02.004.
    1. Fox AN, Skrepnek GH, Miller JL, Schwier NC, Ripley TL. Optimal medical therapy prescribing patterns and disparities identified in patients with acute coronary syndromes at an academic medical center in an area with high coronary heart disease-related mortality. Am J Cardiovasc Drugs. 2018 doi: 10.1007/s40256-018-0308-x.
    1. Kulik A, Ruel M, Jneid H, Ferguson TB, Hiratzka LF, Ikonomidis JS, et al. Secondary prevention after coronary artery bypass graft surgery: a scientific statement from the American Heart Association. Circulation. 2015;131(10):927–964. doi: 10.1161/CIR.0000000000000182.
    1. Nguyen HL, Goldberg RJ, Gore JM, Fox KA, Eagle KA, Gurfinkel EP, et al. Age and sex differences, and changing trends, in the use of evidence-based therapies in acute coronary syndromes: perspectives from a multinational registry. Coron Artery Dis. 2010;21(6):336–344. doi: 10.1097/MCA.0b013e32833ce07c.
    1. Smolina K, Ball L, Humphries KH, Khan N, Morgan SG. Sex disparities in post-acute myocardial infarction pharmacologic treatment initiation and adherence: problem for young women. Circ Cardiovasc Quality and Outcomes. 2015;8(6):586–592. doi: 10.1161/CIRCOUTCOMES.115.001987.
    1. Tran CT, Laupacis A, Mamdani MM, Tu JV. Effect of age on the use of evidence-based therapies for acute myocardial infarction. Am Heart J. 2004;148(5):834–841. doi: 10.1016/j.ahj.2003.11.028.
    1. Ruiz-Bailen M, Aguayo de Hoyos E, Ramos-Cuadra JA, Diaz-Castellanos MA, Issa-Khozouz Z, Reina-Toral A, et al. Influence of age on clinical course, management and mortality of acute myocardial infarction in the Spanish population. Int J Cardiol. 2002;85(2–3):285–296. doi: 10.1016/S0167-5273(02)00187-0.
    1. Skolnick AH, Alexander KP, Chen AY, Roe MT, Pollack CV, Jr, Ohman EM, et al. Characteristics, management, and outcomes of 5,557 patients age > or = 90 years with acute coronary syndromes: results from the CRUSADE Initiative. J Am Coll Cardiol. 2007;49(17):1790–1797. doi: 10.1016/j.jacc.2007.01.066.
    1. Dahl Aarvik M, Sandven I, Dondo TB, Gale CP, Ruddox V, Munkhaugen J, et al. Effect of oral beta-blocker treatment on mortality in contemporary post-myocardial infarction patients: a systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother. 2019;5(1):12–20. doi: 10.1093/ehjcvp/pvy034.
    1. Dondo TB, Hall M, West RM, Jernberg T, Lindahl B, Bueno H, et al. beta-Blockers and mortality after acute myocardial infarction in patients without heart failure or ventricular dysfunction. J Am Coll Cardiol. 2017;69(22):2710–2720. doi: 10.1016/j.jacc.2017.03.578.
    1. Nishino T, Furukawa Y, Kaji S, Ehara N, Shiomi H, Kim K, et al. Distinct survival benefits of angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers in revascularized coronary artery disease patients according to history of myocardial infarction. Circ J. 2013;77(5):1242–1252. doi: 10.1253/circj.CJ-12-0963.
    1. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001;357(9266):1385–1390. doi: 10.1016/S0140-6736(00)04560-8.
    1. Herlitz J, Elmfeldt D, Hjalmarson A, Holmberg S, Malek I, Nyberg G, et al. Effect of metoprolol on indirect signs of the size and severity of acute myocardial infarction. Am J Cardiol. 1983;51(8):1282–1288. doi: 10.1016/0002-9149(83)90299-0.
    1. Pedersen TR. Six-year follow-up of the Norwegian multicenter study on timolol after acute myocardial infarction. N Engl J Med. 1985;313(17):1055–1058. doi: 10.1056/NEJM198510243131705.
    1. Ryden L, Ariniego R, Arnman K, Herlitz J, Hjalmarson A, Holmberg S, et al. A double-blind trial of metoprolol in acute myocardial infarction. Effects on ventricular tachyarrhythmias. N Engl J Med. 1983;308(11):614–618. doi: 10.1056/nejm198303173081102.
    1. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet. 1999;342(8875):821–828.
    1. Gruppo Italiano per lo Studio della Sopravvivenza nell’infarto Miocardico GISSI-3: effects of lisinopril and transdermal glyceryl trinitrate singly and together on 6-week mortality and ventricular function after acute myocardial infarction. Lancet. 1994;343(8906):1115–1122.
    1. ISIS-4 (Fourth International Study of Infarct Survival) Collaborative Group ISIS-4: a randomised factorial trial assessing early oral captopril, oral mononitrate, and intravenous magnesium sulphate in 58,050 patients with suspected acute myocardial infarction. Lancet. 1995;345(8951):669–685. doi: 10.1016/S0140-6736(95)90865-X.
    1. Konishi H, Miyauchi K, Kasai T, Tsuboi S, Ogita M, Naito R, et al. Long-term effect of beta-blocker in ST-segment elevation myocardial infarction in patients with preserved left ventricular systolic function: a propensity analysis. Heart Vessels. 2016;31(4):441–448. doi: 10.1007/s00380-014-0624-2.
    1. Raposeiras-Roubin S, Abu-Assi E, Redondo-Dieguez A, Gonzalez-Ferreiro R, Lopez-Lopez A, Bouzas-Cruz N, et al. Prognostic benefit of beta-blockers after acute coronary syndrome with preserved systolic function. Still relevant today? Revista espanola de cardiologia (English ed). 2015;68(7):585–591. doi: 10.1016/j.rec.2014.07.028.
    1. Kernis SJ, Harjai KJ, Stone GW, Grines LL, Boura JA, O’Neill WW, et al. Does beta-blocker therapy improve clinical outcomes of acute myocardial infarction after successful primary angioplasty? J Am Coll Cardiol. 2004;43(10):1773–1779. doi: 10.1016/j.jacc.2003.09.071.
    1. 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):1730–1737. doi: 10.1136/bmj.318.7200.1730.
    1. Huang BT, Huang FY, Zuo ZL, Liao YB, Heng Y, Wang PJ, et al. Meta-analysis of relation between oral beta-blocker therapy and outcomes in patients with acute myocardial infarction who underwent percutaneous coronary intervention. Am J Cardiol. 2015;115(11):1529–1538. doi: 10.1016/j.amjcard.2015.02.057.
    1. Ozasa N, Kimura T, Morimoto T, Hou H, Tamura T, Shizuta S, et al. Lack of effect of oral beta-blocker therapy at discharge on long-term clinical outcomes of ST-segment elevation acute myocardial infarction after primary percutaneous coronary intervention. Am J Cardiol. 2010;106(9):1225–1233. doi: 10.1016/j.amjcard.2010.06.048.
    1. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362–e425. doi: 10.1161/CIR.0b013e3182742cf6.

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