Abstract 18279: Contemporary Trends of Optimal Evidence-Based Medical Therapy at Discharge for Patients Surviving Acute Myocardial Infarction From Korea Acute Myocardial Infarction Registry

Abstract

Background: Most published studies about the contemporary trends in optimal medical therapy (OMT) were conducted more than 5 years ago. Furthermore, In Asia, only limited data are available for the recent trend of OMT at discharge after acute myocardial infarction (AMI). The aims of this study is (1) to describe the contemporary, as well as changing, prescribing of 4 effective cardiac medications in post-MI hospital survivors and (2) to determine whether use of 4 effective cardiac medications at the time of hospital discharge differ on the basis of age or gender. Methods: The Korea AMI Registry (November 2005-June 2011) were multicenter observational study. We examined the discharge medications among 22,646 post-MI survivors who did not have any documented contraindications to anti-platelet drugs, beta-blockers (BBs), angiotensin converting enzyme inhibitors (ACE-I)/ angiotensin II receptor blockers (ARBs) or statins in 6 periods by 12-month interval. OMT was defined as the use of all 4 indicated medications. Results: Particularly marked relative increase from period 1 to period 6 were observed in the use of BBs (from 70.3% to 84.5%) and statins (from 77.4% to 83.2%), whereas less dramatic increases were noted in the use of ACE-I/ARBs. Among ACE-Is/ARBs users, marked increases in the use of ARBs (from 17.4% to 32.2%) and declines in the use of ACE-Is (65.7% to 49.3%) were observed over time. Consistent with these trends, there were also marked increases in the use of OMT (from 48.9% to 62.3%). The odds ratios of the use of OMT from period 1 to period 6 were as follows: 1, 1.11 (p=0.034), 1.18 (p=0.001), 1.32 (p <0.001), 1.41 (p <0.001), and 1.57 (p <0.001), respectively, in overall. The use of OMT was significantly higher in men than women over time (p <0.05). Among patients aged 65 years or less, the use of OMT was significantly higher in men than women, whereas there was no significant difference between men and women over time among patients aged 65 to 75 years. Among patients aged more than 75 years, the use of OMT was significantly higher in women than men over time. Conclusions: National health improvement program implemented from 2007 markedly increased the use of all 4 effective cardiac medications, particularly in elderly women who were no more undertreated in our study.