Cumulative Adherence to Secondary Prevention Guidelines and Mortality After Acute Myocardial Infarction

Autor: Thomas K. Leong, Eleanor Levin, Jamal S. Rana, Alan S. Go, Anthony N. DeMaria, Sue Hee Sung, Catherine Lee, Matthew D. Solomon, Stephen Sidney, Marc G. Jaffe
Rok vydání: 2020
Předmět:
Male
medicine.medical_specialty
Time Factors
Myocardial Infarction
030204 cardiovascular system & hematology
Risk Assessment
California
Cigarette Smoking
Medication Adherence
03 medical and health sciences
0302 clinical medicine
Recurrence
Risk Factors
Secondary Prevention
Humans
Medicine
030212 general & internal medicine
Myocardial infarction
guideline adherence
Original Research
Aged
Hypolipidemic Agents
Aged
80 and over
Secondary prevention
Quality and Outcomes
business.industry
Guideline adherence
Cardiovascular Agents
Guideline
Middle Aged
Protective Factors
medicine.disease
mortality
Treatment Outcome
Survival benefit
Emergency medicine
Patient Compliance
Female
Smoking Cessation
Cardiology and Cardiovascular Medicine
business
Risk Reduction Behavior
Health Services and Outcomes Research
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: 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 AMI was evaluated with Cox proportional hazard models. To allow patients time to achieve low‐density lipoprotein cholesterol 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: OpenAIRE
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