Abstract
There are few nationwide descriptive studies of longitudinal drug use and residual cardiovascular risk in patients with myocardial infarction (MI) in contemporary clinical practice. The objectives of this work were to describe characteristics and longitudinal cardiovascular drug use of patients with a first acute MI in Norway, and to quantify residual risks of cardiovascular events and death. Using nationwide health registries in Norway, we identified 43 750 adults with a first MI (2010 to 2015) and ≥1 prescription for antiplatelet medication. We described cardiovascular medication post-MI and calculated residual cardiovascular risks. Between 3 months and 13-15 months post MI, medication use dropped from 93.3% to 75.1% for low-dose aspirin, 78.1% to 11.0% for dual antiplatelet therapy, 91.6% to 78.7% for antihypertensives, and 88.0% to 70.7% for lipid-lowering therapy. Incidence rate ratios (IRRs) for recurrent MI were similar between subpopulations at 12 months and notably different at 12-36 months. IRRs (95% CIs) at 12-36 months were 1.52 (1.26-1.82) for 65-74 years, 2.26 (1.88-2.71) for 75-84 years, and 3.97 (3.29-4.79) for ≥85 years (vs. 18-49 years), 2.42 (2.18-2.69) for those with ischaemic heart disease (IHD), 2.26 (1.97-2.59) for peripheral artery disease (PAD), 2.17 (1.98-2.36) for hypertension, and 1.82 (1.65-2.01) for diabetes. In conclusion, secondary prevention medication use 13-15 months following a first MI is suboptimal among patients in Norway. The elderly and those with IHD, PAD, diabetes, or hypertension are at high-risk for recurrent MI/stroke/death and should be managed closely beyond the first year.
Highlights
Coronary heart disease (CHD) is a leading cause of death in Europe, accounting for 1.8 million deaths each year [1]
Risks of recurrent myocardial infarction (MI) were broadly similar between patient subgroups during the first 12 months of followup, reduced risks were seen for females (IRR 0.94, 95% confidence interval (CI): 0.89–0.99) and for patients aged 65– 74 years (IRR 0.84, 95% CI: 0.77–0.93) or 75–84 years (IRR 0.81, 95% CI: 0.73–0.89) when compared with those aged 18–49 years
A clear increase in risk was seen with increasing age; compared with patients aged 18–49 years at the index date, incidence rate ratio (IRR) were 1.52 for 65–74 years, 2.26 for 75–84 years, and 3.97 for ≥85 years
Summary
Coronary heart disease (CHD) is a leading cause of death in Europe, accounting for 1.8 million deaths each year [1]. Population-based surveys from Tromsø, Norway, have shown temporal trends towards a lower proportion of severe infarctions among patients treated for a MI [4], meaning that a higher proportion of these patients are requiring long-term secondary prevention treatment. Around 1-year of dual antiplatelet therapy (DAPT) with low-dose aspirin and a P2Y12 receptor inhibitor, and longer-term treatment with aspirin monotherapy and lipid-lowering therapy remains the cornerstone of pharmacotherapy for secondary cardiovascular prevention following MI [5, 6]. Despite the availability and frequent use of these effective preventative treatments, residual cardiovascular risks remain evident. Optimising secondary prevention pharmacotherapy is an essential component in reducing residual risks, and identification of patient groups in whom these risks are greatest would help guide more targeted prevention measures
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