Clinical InvestigationAcute Ischemic Heart DiseaseSuboptimal use of evidence-based medical therapy in patients with acute myocardial infarction from the Korea Acute Myocardial Infarction Registry: Prescription rate, predictors, and prognostic value
Section snippets
Study design and patient population
KAMIR is a Korean, prospective, open, observational, multicenter online registry of AMI with support of Korean Society of Cardiology (KSC) since November 2005. The 50 participating hospitals are capable of primary PCI. Details of the KAMIR have been published.12
Between November 2005 and January 2008, 14,871 patients suspected to have AMI at admission were enrolled in the KAMIR and 11,942 patients with a final diagnosis of AMI were analyzed in this study. Of these patients, baseline clinical
Results
The baseline characteristics of the overall study patients are shown in Table I. The mean age was 63.8 ± 12.5 years old, and 6,170 patients (72.2%) were men. Of the 9,294 patients with AMI, 326 (3.5%), 4,284 (46.1%), and 4,684 (50.4%) patients were discharged on <2 drugs, 2 to 3 drugs, and all 4 indicated drugs, respectively. The discharge prescription rates of antiplatelet agents, β-receptor blockers, ACE-Is/ARBs, and statins were 99.0%, 72.7%, 81.5%, and 77.2%, respectively (Figure 1). In
Discussion
Medications such as antiplatelet drugs, β-blockers, ACE-Is/ARBs, and statins have been associated with significantly improved outcomes in patients presenting with AMI regardless of the geographic location.2, 3 In the present study, even with the evidence of benefit, the prescription rates in eligible patients varied from 99% for use of antiplatelet drugs at discharge to 73% for β-blockers at discharge in overall patients. Only half of the eligible patients received OMT at discharge. Our results
Conclusion
This study provides useful information on the pattern of discharge medication use and clinical outcome at 6 months in patients receiving OMT in Asian populations. Despite strong benefits of recommended cardiac drugs, these pharmacologic agents are prescribed at suboptimal rates, particularly in patients with high-risk features who may derive the greater therapeutic benefits. New educational strategies and initiatives are needed to increase the use of these secondary preventive medical therapies
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A list of participating Korea Acute Myocardial Infarction Registry Investigators can be found in Am J Cardiol 2009;104:182-9.