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A Multinational Perspective

Robert J. Goldberg, PhD; Frederick A. Spencer, MD; Philippe Gabriel Steg, MD; Marcus Flather, MD; Gilles Montalescot, MD, PhD; Enrique P. Gurfinkel, MD; Brian M. Kennelly, MB, ChB, PhD; Shaun G. Goodman, MD; Rebecca Dedrick, MPH; Joel M. Gore, MD; for the Global Registry of Acute Coronary Events Investigators

Arch Intern Med. 2007;167(16):1766-1773.

Background  Current practice guidelines recommend the routine use of several effective cardiac medications in hospital survivors of acute myocardial infarction (AMI).

Methods  We explored a recent 5-year (2000-2005) trend in hospital use of aspirin, β-blockers, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, and combinations thereof, in 26 413 adult men and women without contraindications to any of these therapies discharged after AMI from hospitals located in 14 countries that were included in the Global Registry of Acute Coronary Events.

Results  Relatively steady increases in the use of ACE inhibitors, β-blockers, and statin therapy were observed over time, with particularly marked increases in the use of lipid-lowering therapy (from 45% in 2000 to 85% in 2005). Aspirin use remained high (by approximately 95% of patients after AMI) during all periods examined. The percentage of hospital survivors treated with all 4 cardiac medications increased from 23% in 2000 to 58% during 2005. Advancing age ( 65 years), female sex, medical history of heart failure or stroke, and development of atrial fibrillation during hospitalization were associated with underuse of combination medical therapy. Relatively similar factors were associated with the underuse of combination medical therapy in patients with ST-segment elevation AMI and non–ST-segment elevation AMI.

Conclusions  Our results suggest encouraging increases over time in the use of combination medical therapy in patients hospitalized with AMI without contraindications to these medications. Educational efforts designed to increase the use of these therapies, as well as efforts to simplify medication regimens and enhance rates of adherence, remain warranted.

Author Affiliations: Department of Community Health, Brown University, Providence, Rhode Island (Dr Goldberg); Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester (Drs Goldberg and Gore and Ms Dedrick); Department of Health Sciences, McMaster University, Hamilton, Ontario, Canada (Dr Spencer); Department of Cardiology, Hôpital Bichat, Paris, France (Dr Steg); Clinical Trial and Evaluation Unit, Royal Brompton and Harefield National Health Service Trust, London, England (Dr Flather); Institut de Cardiologie, Centre Hospitalier Universitaire Pitié-Salpêtrière, Paris (Dr Montalescot); Instituto de Cardiologia y Cirugia Cardiovascula, ICYCC Favaloro Foundation, Buenos Aires, Argentina (Dr Gurfinkel); Department of Cardiology, Hoag Memorial Hospital Presbyterian, Newport Beach, California (Dr Kennelly); Canadian Heart Research Centre, Toronto, Ontario (Dr Goodman); and Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, University of Toronto, Toronto (Dr Goodman).
Group Information: A list of the Global Registry of Acute Coronary Events Investigators is available at http://www.outcomes-umassmed.org/GRACE/study.cfm.