Abstract
Despite improvements in the treatment of myocardial infarction (MI), risk-associated management disparities may exist. We investigated this issue including temporal trends in a large MI cohort (n = 179,291) registered 2005–2017 in SWEDEHEART. Multivariable models were used to study the associations between risk categories according to the GRACE 2.0 score and coronary procedures (timely reperfusion, invasive assessment ≤ 3 days, in-hospital coronary revascularization), pharmacological treatments (P2Y12-blockers, betablockers, renin–angiotensin–aldosterone-system [RAAS]-inhibitors, statins), structured follow-up and secondary prevention (smoking cessation, physical exercise training). High-risk patients (n = 76,295 [42.6%]) experienced less frequent medical interventions compared to low/intermediate-risk patients apart from betablocker treatment. Overall, intervention rates increased over time with more pronounced increases seen in high-risk patients compared to lower-risk patients for in-hospital coronary revascularization (+ 23.6% vs. + 12.5% in patients < 80 years) and medication with P2Y12-blockers (+ 22.2% vs. + 7.8%). However, less pronounced temporal increases were noted in high-risk patients for medication with RAAS-blockers (+ 8.5% vs. + 13.0%) and structured follow-up (+ 31.6% vs. + 36.3%); pinteraction < 0.001 for all. In conclusion, management of high-risk patients with MI is improving. However, the lower rates of follow-up and of RAAS-inhibitor prescription are a concern. Our data emphasize the need of continuous quality improvement initiatives.
Highlights
Despite improvements in the treatment of myocardial infarction (MI), risk-associated management disparities may exist
TOTAL-AMI uses data from SWEDEHEART (Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies) which is a registry collecting data from patients admitted to Swedish coronary care units or other specialized facilities because of suspected acute coronary syndrome
Excluding patients who did not receive any of these interventions left 8168 (12.6%) ST-elevation MI (STEMI) patients with missing data on early reperfusion and 704 (0.7%) non-ST-elevation MI (NSTEMI) patients with missing data on coronary angiography ≤ 3 days
Summary
Despite improvements in the treatment of myocardial infarction (MI), risk-associated management disparities may exist We investigated this issue including temporal trends in a large MI cohort (n = 179,291) registered 2005–2017 in SWEDEHEART. The past decades have seen considerable improvements in the management of patients with myocardial infarction (MI) This applies to the more frequent use of invasive treatments and of medications with proven prognostic benefit[1,2,3]. Using the GRACE 2.0 score, the aims of the present study were (1) to investigate risk-associated management disparities in a large cohort of MI patients during the course of disease, from early invasive assessment to secondary prevention, and (2) to assess whether the magnitude of potentially existing treatment disparities might have changed over time. We hypothesized that management of MI patients still differs among patient categories at different levels of risk whilst the broad uptake of guideline-based management recommendations[1,2,3] has reduced the dimension of this issue
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