| Autor: |
Solomon MD; Division of Research Kaiser Permanente Northern California Oakland CA.; Division of Cardiology Kaiser Permanente Oakland Medical Center Oakland CA., Leong TK; Division of Research Kaiser Permanente Northern California Oakland CA., Levin E; Division of Cardiology Kaiser Permanente Santa Clara Medical Center Santa Clara CA., Rana JS; Division of Research Kaiser Permanente Northern California Oakland CA.; Division of Cardiology Kaiser Permanente Oakland Medical Center Oakland CA., Jaffe MG; Division of Endocrinology Kaiser Permanente South San Francisco Medical Center San Francisco CA., Sidney S; Division of Research Kaiser Permanente Northern California Oakland CA., Sung SH; Division of Research Kaiser Permanente Northern California Oakland CA., Lee C; Division of Research Kaiser Permanente Northern California Oakland CA., DeMaria A; Division of Cardiology University of California at San Diego CA., Go AS; Division of Research Kaiser Permanente Northern California Oakland CA.; Departments of Epidemiology, Biostatistics and Medicine University of California San Francisco CA.; Departments of Medicine, Health Research and Policy Stanford University Palo Alto CA. |
| Jazyk: |
angličtina |
| Zdroj: |
Journal of the American Heart Association [J Am Heart Assoc] 2020 Mar 17; Vol. 9 (6), pp. e014415. Date of Electronic Publication: 2020 Mar 05. |
| DOI: |
10.1161/JAHA.119.014415 |
| Abstrakt: |
Background The survival benefit associated with cumulative adherence to multiple clinical and lifestyle-related guideline recommendations for secondary prevention after acute myocardial infarction (AMI) is not well established. Methods and Results We examined adults with AMI (mean age 68 years; 64% men) surviving at least 30 (N=25 778) or 90 (N=24 200) days after discharge in a large integrated healthcare system in Northern California from 2008 to 2014. The association between all-cause death and adherence to 6 or 7 secondary prevention guideline recommendations including medical treatment (prescriptions for β-blockers, renin-angiotensin-aldosterone system inhibitors, lipid medications, and antiplatelet medications), risk factor control (blood pressure <140/90 mm Hg and low-density lipoprotein cholesterol <100 mg/dL), and lifestyle approaches (not smoking) at 30 or 90 days after AMI was evaluated with Cox proportional hazard models. To allow patients time to achieve low-density lipoprotein cholesterol <100 mg/dL, this metric was examined only among those alive 90 days after AMI. Overall guideline adherence was high (35% and 34% met 5 or 6 guidelines at 30 days; and 31% and 23% met 6 or 7 at 90 days, respectively). Greater guideline adherence was independently associated with lower mortality (hazard ratio, 0.57 [95% CI, 0.49-0.66] for those meeting 7 and hazard ratio, 0.69 [95% CI, 0.61-0.78] for those meeting 6 guidelines versus 0 to 3 guidelines in 90-day models, with similar results in the 30-day models), with significantly lower mortality per each additional guideline recommendation achieved. Conclusions In a large community-based population, cumulative adherence to guideline-recommended medical therapy, risk factor control, and lifestyle changes after AMI was associated with improved long-term survival. Full adherence was associated with the greatest survival benefit. |
| Databáze: |
MEDLINE |
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