Abstract
Despite the significant benefits of secondary prevention (SP) medication after acute myocardial infarction (MI), evidence suggests that these medications are neither consistently prescribed nor appropriately adhered to by patients. The aim of this study was to investigate the role of general practitioners (GPs) and patients regarding discontinuation of SP medication after MI and reasons for discontinuation. In this observational study, GPs of patients who had suffered acute MI provided information on discontinuation of SP medication 6 and 12 months after hospital discharge. A questionnaire-based approach was used (a) to assess the consistent use of SP medication after MI, (b) to determine reasons for stopping SP medication, (c) to quantify the involvement of GPs and patients regarding discontinuation, and (d) to analyse potential factors that are associated with discontinuation of medication. Of 204 subjects 6 and 12 months after hospital discharge 83% and 75% patients, respectively, were still on recommended SP medication. Overall, one or more SP medications were stopped (53 medications) or modified (15 medications) in 52 (25%) patients. Adverse side effects were the main reason for stopping medication (63%). GPs reported being responsible for initiating discontinuation or modification more frequently than patients (62% vs 38%, p = 0.065). The consistent use of evidence-based pharmacotherapy 6 and 12 months after myocardial infarction was adequate. Three out of four patients were still on recommended SP medication after 1 year of follow-up. Two-thirds of medication discontinuations were initiated by GPs, predominantly because of side effects.
Highlights
Coronary artery disease (CAD) is one of the leading causes of death in developed countries
We received a list of all patients treated for acute coronary syndrome (ACS) in 2008 from the Department of Cardiology at the University Hospital of Basel, including discharge reports with information on the medication at hospital discharge (n = 708)
64 (9%) patients did not fulfil the criteria of myocardial infarction (MI) according to current guidelines or were hospitalised for unstable angina without rise and/or fall of cardiac biomarkers [16]
Summary
Coronary artery disease (CAD) is one of the leading causes of death in developed countries. Dual antiplatelet therapy, combining aspirin and an adenosine diphosphate (ADP) receptor blocker (clopidogrel, prasugrel or ticagrelor), is recommended in patients with MI who are undergoing primary percutaneous coronary intervention (for up to 12 months). It is well established that angiotensin-converting enzyme (ACE) inhibitors should be given to patients with an impaired ejection fraction (
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