Abstract P251: Gender and Age Influence the Utilization of Recommended Medications at Discharge in Post Myocardial Infarction Population

Abstract

Background: ACC/AHA guidelines strongly recommend the use of aspirin, beta blockers, clopidogrel, statin, and angiotensin converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB) in post myocardial infarction (MI) patients. Reductions in mortality have been demonstrated with consistent administration of recommended therapies. Patients who discontinue taking evidence-based medications are at increased mortality risk. The purpose of this study was to identify gender and age based differences in drug therapies at discharge in post MI patients at a tertiary care teaching hospital. Methods: We retrospectively analyzed data of 610 consecutive patients admitted with MI from 2006 to 2007. The use of appropriate discharge medications was compared using chi-square test. Results: There were 371 males (60.8%) with mean age 65.4 ±13 years and 239 females (39.2%) with mean age 73 ±12 years. Medications Male (%) Female (%) OR (CI) p value Aspirin 97.9 93.2 3.4 (1.3-8.5) 0.006 Clopidogrel 77.6 63.6 1.98(1.4-2.87) <0.001 Beta blocker 94.6 84.4 3.2 (1.75-5.9) <0.001 Statin 88 79 1.9 (1.2-3.1) 0.006 ACEI/ARB 70 58.5 1.66(1.15-2.3) 0.006 Clopidogrel use was 59% and 84.4% in patients greater than 70 years and less than 70 years respectively (OR= 0.26, CI 0.18-0.39, p = <0.001). There was no difference in use of other medications by an age cut off of 70 years. Conclusions: In an era of evidence-based guidelines and quality improvement initiatives, there is still under utilization of recommended medications in women even though they receive same treatment benefit. Elderly patients in spite of being at high risk for recurrent events were less likely to be discharged with dual antiplatelet therapy.