Friday, September 14, 2007

GRACE - increased medical therapy use in AMI patients

GRACE shows 'encouraging' increased medical therapy use in AMI patients

By Caroline Price

14 September 2007

Arch Intern Med 2007; 167: 1766-1773

MedWire News: Use of both single and combination medical therapy in patients hospitalized with acute myocardial infarction (AMI) increased from 2000 through 2005, suggest results from the Global Registry of Acute Coronary Events (GRACE).

Robert Goldberg (Brown University, Providence, Rhode Island, USA) and colleagues explored use of four effective cardiac medications, namely aspirin, beta blockers, angiotensin converting enzyme (ACE) inhibitors, and lipid-lowering agents at discharge in 26,413 adult men and women without contraindications to any of the drugs.

Increases were seen in singular use of three out of the four therapies, particularly that of statins, which increased from 45% of patients in 2000 to 85% in 2005. ACE inhibitor use increased from 63% to 77%, and beta blocker use from 83% to 91%.

There was little or no increase in aspirin over time, since this therapy was already being used in most AMI hospital survivors (around 95%).

There were marked increases in the use of multiple medications, particularly in use of all four combined, which increased from 23% of patients in the first half of 2000 to 58% in the second half of 2005.

Virtually identical trends were seen in the use of single and combination therapy in ST-elevation myocardial infarction (STEMI) and non-STEMI patients.

Further analysis revealed that patients of advancing age (=65 years), women, and those with a history of heart failure or stroke, who were hospitalized in participating centers in Argentina and Brazil, or developed atrial fibrillation during hospitalization, were more likely to be discharged receiving one, two, or three instead of all four medications.

Similar factors were associated with underuse of all four medications when STEMI or non-STEMI patients were studied separately, and with use of relatively few compared with three medications, the authors say in the Archives of Internal Medicine.

However, they conclude: "Despite these encouraging trends, gaps in the use of combination medical therapies continue to exist. Closing this gap will require novel and concerted efforts."

They say increased understanding and minimization of drug interactions, increased use of combination tablets, and education about the differences between "polypharmacy" and effective combination therapy are needed to this end.

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