While secondary prevention improves prognosis after acute myocardial infarction (AMI), previous studies have suggested suboptimal guideline adherence, lack of improvement over time and gender differences. This study contributes contemporary data from a large national cohort.
Method
We identified 51,620 patients <75 years examined at two and/or twelve months post AMI in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Risk factor control and readmissions at one year were compared between the 2005 and 2012 cohorts, and between genders.
Results
Lipid control (LDL-cholesterol <2.5 mmol/L) improved from 67.9% to 71.1% (p = 0.016) over time, achieved by 67.9% vs 63.3%, p < 0.001 of men vs women. Blood pressure control (<140 mmHg systolic) increased over time (59.1% vs 69.5%, p < 0.001 in 2005 and 2012 cohorts) and was better in men (66.4% vs 61.9%, p < 0.001). Smoking cessation rate was 55.6% without differences between genders or over time. Cardiac readmissions occurred in 18.2% of women and 15.5% of men, decreasing from 2005 to 2012 (20.8% vs 14.9%). Adjusted odds ratio was 1.22 (95% CI 1.14–1.32) for women vs men and 0.94 (95% CI 0.92–0.96) for the 2012 vs the 2005 cohort.
Conclusions
Although this study compares favourably to previous studies of risk factor control post AMI, improvement over time was mainly seen regarding blood pressure, revealing substantial remaining preventive potential. The reasons for gender differences seen in risk factor control and readmissions require further analysis.
HahnJLessardDYarzebskiJ. A community-wide perspective into changing trends in the utilization of diagnostic and interventional procedures in patients hospitalized with acute myocardial infarction. Am Heart J2007; 153: 594–605.
2.
JernbergTJohansonPHeldC. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA2011; 305: 1677–1684.
3.
BuchPRasmussenSGislasonGH. Temporal decline in the prognostic impact of a recurrent acute myocardial infarction 1985 to 2002. Heart2007; 93: 210–215.
4.
FoxKACarruthersKFDunbarDR. Underestimated and under-recognized: the late consequences of acute coronary syndrome (GRACE UK-Belgian Study). Eur Heart J2010; 31: 2755–2764.
5.
GrahamIAtarDBorch-JohnsenK. European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil2007; 14(Suppl 2): S1–113.
6.
SmithSCJrAllenJBlairSN. AHA/ACC Guidelines for Secondary Prevention for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2006 Update: Endorsed by the National Heart, Lung, and Blood Institute. Circulation2006; 113: 2363–2372.
7.
Members: ATFPerkJDe BackerG. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J2012; 33: 1635–1701.
8.
ReinerZCatapanoALDe BackerG. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J2011; 32: 1769–1818.
9.
PetersonEDRoeMTMulgundJ. Association between hospital process performance and outcomes among patients with acute coronary syndromes. JAMA2006; 295: 1912–1920.
10.
KotsevaKWoodDDe BackerG. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet2009; 373: 929–940.
11.
VedinOHagstromEStewartR. Secondary prevention and risk factor target achievement in a global, high-risk population with established coronary heart disease: Baseline results from the STABILITY study. Eur J Preventive Cardiol2013; 20: 678–685.
12.
ColellaTJGravelySMarzoliniS. Sex bias in referral of women to outpatient cardiac rehabilitation? A meta-analysis. Eur J Preventive Cardiol2015; 22(4): 423–441.
13.
CooneyMTKotsevaKDudinaA. Determinants of risk factor control in subjects with coronary heart disease: A report from the EUROASPIRE III investigators. Eur J Preventive Cardiol2013; 20: 686–691.
14.
LawessonSSAlfredssonJFredriksonM. Time trends in STEMI–improved treatment and outcome but still a gender gap: A prospective observational cohort study from the SWEDEHEART register. BMJ open2012; 2: e000726–e000726.
15.
LauffenburgerJCRobinsonJGOramasionwuC. Racial/ethnic and gender gaps in the use of and adherence to evidence-based preventive therapies among elderly Medicare Part D beneficiaries after acute myocardial infarction. Circulation2014; 129: 754–763.
16.
JernbergTAttebringMFHambraeusK. The Swedish Web-system for enhancement and development of evidence-based care in heart disease evaluated according to recommended therapies (SWEDEHEART). Heart2010; 96: 1617–1621.
17.
BrownJRConleySMNilesNW2nd. Predicting readmission or death after acute ST-elevation myocardial infarction. Clin Cardiol2013; 36: 570–575.
18.
KociolRDLopesRDClareR. International variation in and factors associated with hospital readmission after myocardial infarction. JAMA2012; 307: 66–74.
19.
JernbergTHasvoldPHenrikssonM. Cardiovascular risk in post-myocardial infarction patients: nationwide real world data demonstrate the importance of a long-term perspective. Eur Heart J2015. . Epub ahead of print 13 January 2015. DOI: 10.1093/eurheartj/ehu505.
20.
WilsonPWD'AgostinoRSrBhattDL. An international model to predict recurrent cardiovascular disease. Am J Med2012; 125: 695–703.
21.
KotsevaKWoodDDe BackerG. EUROASPIRE III: A survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil2009; 16: 121–137.
22.
HambraeusKLindhagenLTydenP. Target-attainment rates of low-density lipoprotein cholesterol using lipid-lowering drugs one year after acute myocardial infarction in sweden. Am J Cardiol2014; 113: 17–22.
23.
FranconiFBrunelleschiSSteardoL. Gender differences in drug responses. Pharmacol Res2007; 55: 81–95.
24.
NguyenTNAbramsonBLGalluzziA. Temporal trends and referral factors for cardiac rehabilitation post-acute coronary syndrome in ontario: Insights from the Canadian Global Registry of Acute Coronary Events. Can J Cardiol2013; 29: 1604–1609.
25.
GoelKLennonRJTilburyRT. Impact of cardiac rehabilitation on mortality and cardiovascular events after percutaneous coronary intervention in the community. Circulation2011; 123: 2344–2352.
26.
(Anonymous) Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. FRagmin and Fast Revascularisation during InStability in Coronary artery disease Investigators. Lancet1999; 354: 708–715.
27.
ChanWCWrightCTobiasM. Explaining trends in coronary heart disease hospitalisations in New Zealand: Trend for admissions and incidence can be in opposite directions. Heart2008; 94: 1589–1593.
28.
GullikssonMWedelHKosterM. Hazard function and secular trends in the risk of recurrent acute myocardial infarction: 30 years of follow-up of more than 775,000 incidents. Circ Cardiovasc Qual Outcomes2009; 2: 178–185.
29.
HoekstraJWPollackCVJrRoeMT. Improving the care of patients with non-ST-elevation acute coronary syndromes in the emergency department: the CRUSADE initiative. Acad Emerg Med2002; 9: 1146–1155.
30.
MehtaRHRoeMTChenAY. Recent trends in the care of patients with non-ST-segment elevation acute coronary syndromes: Insights from the CRUSADE initiative. Archiv Internal Med2006; 166: 2027–2034.
31.
CarlhedRBojestigMWallentinL. Improved adherence to Swedish national guidelines for acute myocardial infarction: The Quality Improvement in Coronary Care (QUICC) study. Am Heart J2006; 152: 1175–1181.
