Journal - European Heart Journal

Abstract :

; Published online 6 January 2006. .Aims To study initiation, dosages, and compliance with beta-blockers,angiotensin-converting enzyme (ACE)-inhibitors, and statinsin patients after acute myocardial infarction (AMI) and to identifylikely targets for improvement.Methods and results Patients admitted with first AMI between1995 and 2002 were identified by linking nationwide administrativeregisters. A total of 55 315 patients survived 30 daysafter discharge and were included; 58.3% received beta-blockers,29.1% ACE-inhibitors, and 33.5% statins. After 1, 3, and 5 years,78, 64, and 58% of survivors who had started therapy were stillreceiving beta-blockers, 86, 78, and 74% were receiving ACE-inhibitors,and 85, 80, and 82% were receiving statins, respectively. Increasedage and female sex were associated with improved compliance.The dosages prescribed were generally 50% or less of the dosagesused in clinical trials, and dosages did not increase duringthe observation period. Patients who did not start treatmentshortly after discharge had a low probability of starting treatmentlater.Conclusion The main problem with underuse of recommended treatmentafter AMI is that treatment is not initiated at an appropriatedosage shortly after AMI. A focused effort in the immediatepost-infarction period would appear to provide long-term benefit.