Improvements in Long-Term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge. A 10-Year Trend Analysis

Soko Setoguchi Iwata, Robert J. Glynn, Jerry Avorn, Murray A. Mittleman, Raisa Levin, Wolfgang C. Winkelmayer

Research output: Contribution to journalArticle

139 Citations (Scopus)

Abstract

Objectives: We sought to assess the relationship between increasing use of cardiovascular medications and trends in long-term prognosis after myocardial infarction (MI) in the elderly. Background: During the past decade, statins, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin-II receptor blockers (ARBs) have been increasingly used after MI. However, little is known about the relationship between increasing use of these medications and improvements in prognosis after MI. Methods: Using data from pharmacy assistance programs and Medicare in 2 states (1995 to 2004), we identified patients with MI who survived ≥30 days after discharge. We assessed age, gender, race, comorbidities, and coronary interventions during the MI hospitalization and recorded filled prescriptions for statins, BBs, ACEIs/ARBs, or antiplatelet agents within 30 days after discharge. All patients were tracked until they died or until the end of the eligibility/study period. We built multivariate Cox proportional hazards regression models to assess trends in long-term mortality and the contribution to increasing medication use after MI. Results: Of 21,484 patients identified, 12,142 died during 74,982 person-years of follow-up. After adjusting for demographics and comorbidities, we found that mortality after MI decreased significantly from 1995 to 2004 (hazard ratio for annual trend 0.97; 95% confidence interval 0.97 to 0.98), a 3% reduction in mortality each year. Adjusting for the use of statins, BBs, ACEIs/ARBs, and antiplatelet drugs after discharge completely eliminated the association between time trend and mortality (hazard ratio 1.00; 95% confidence interval 0.99 to 1.01). Conclusions: The observed improvement in long-term mortality in elderly patients with MI may be mainly due to increased use of cardiovascular medications after discharge.

Original languageEnglish (US)
Pages (from-to)1247-1254
Number of pages8
JournalJournal of the American College of Cardiology
Volume51
Issue number13
DOIs
StatePublished - Apr 1 2008
Externally publishedYes

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Cardiovascular Agents
Myocardial Infarction
Mortality
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Platelet Aggregation Inhibitors
Comorbidity
Confidence Intervals
Medicare
Proportional Hazards Models
Prescriptions
Hospitalization
Demography

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Setoguchi Iwata, Soko ; Glynn, Robert J. ; Avorn, Jerry ; Mittleman, Murray A. ; Levin, Raisa ; Winkelmayer, Wolfgang C. / Improvements in Long-Term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge. A 10-Year Trend Analysis. In: Journal of the American College of Cardiology. 2008 ; Vol. 51, No. 13. pp. 1247-1254.
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abstract = "Objectives: We sought to assess the relationship between increasing use of cardiovascular medications and trends in long-term prognosis after myocardial infarction (MI) in the elderly. Background: During the past decade, statins, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin-II receptor blockers (ARBs) have been increasingly used after MI. However, little is known about the relationship between increasing use of these medications and improvements in prognosis after MI. Methods: Using data from pharmacy assistance programs and Medicare in 2 states (1995 to 2004), we identified patients with MI who survived ≥30 days after discharge. We assessed age, gender, race, comorbidities, and coronary interventions during the MI hospitalization and recorded filled prescriptions for statins, BBs, ACEIs/ARBs, or antiplatelet agents within 30 days after discharge. All patients were tracked until they died or until the end of the eligibility/study period. We built multivariate Cox proportional hazards regression models to assess trends in long-term mortality and the contribution to increasing medication use after MI. Results: Of 21,484 patients identified, 12,142 died during 74,982 person-years of follow-up. After adjusting for demographics and comorbidities, we found that mortality after MI decreased significantly from 1995 to 2004 (hazard ratio for annual trend 0.97; 95{\%} confidence interval 0.97 to 0.98), a 3{\%} reduction in mortality each year. Adjusting for the use of statins, BBs, ACEIs/ARBs, and antiplatelet drugs after discharge completely eliminated the association between time trend and mortality (hazard ratio 1.00; 95{\%} confidence interval 0.99 to 1.01). Conclusions: The observed improvement in long-term mortality in elderly patients with MI may be mainly due to increased use of cardiovascular medications after discharge.",
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Improvements in Long-Term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge. A 10-Year Trend Analysis. / Setoguchi Iwata, Soko; Glynn, Robert J.; Avorn, Jerry; Mittleman, Murray A.; Levin, Raisa; Winkelmayer, Wolfgang C.

In: Journal of the American College of Cardiology, Vol. 51, No. 13, 01.04.2008, p. 1247-1254.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Improvements in Long-Term Mortality After Myocardial Infarction and Increased Use of Cardiovascular Drugs After Discharge. A 10-Year Trend Analysis

AU - Setoguchi Iwata, Soko

AU - Glynn, Robert J.

AU - Avorn, Jerry

AU - Mittleman, Murray A.

AU - Levin, Raisa

AU - Winkelmayer, Wolfgang C.

PY - 2008/4/1

Y1 - 2008/4/1

N2 - Objectives: We sought to assess the relationship between increasing use of cardiovascular medications and trends in long-term prognosis after myocardial infarction (MI) in the elderly. Background: During the past decade, statins, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin-II receptor blockers (ARBs) have been increasingly used after MI. However, little is known about the relationship between increasing use of these medications and improvements in prognosis after MI. Methods: Using data from pharmacy assistance programs and Medicare in 2 states (1995 to 2004), we identified patients with MI who survived ≥30 days after discharge. We assessed age, gender, race, comorbidities, and coronary interventions during the MI hospitalization and recorded filled prescriptions for statins, BBs, ACEIs/ARBs, or antiplatelet agents within 30 days after discharge. All patients were tracked until they died or until the end of the eligibility/study period. We built multivariate Cox proportional hazards regression models to assess trends in long-term mortality and the contribution to increasing medication use after MI. Results: Of 21,484 patients identified, 12,142 died during 74,982 person-years of follow-up. After adjusting for demographics and comorbidities, we found that mortality after MI decreased significantly from 1995 to 2004 (hazard ratio for annual trend 0.97; 95% confidence interval 0.97 to 0.98), a 3% reduction in mortality each year. Adjusting for the use of statins, BBs, ACEIs/ARBs, and antiplatelet drugs after discharge completely eliminated the association between time trend and mortality (hazard ratio 1.00; 95% confidence interval 0.99 to 1.01). Conclusions: The observed improvement in long-term mortality in elderly patients with MI may be mainly due to increased use of cardiovascular medications after discharge.

AB - Objectives: We sought to assess the relationship between increasing use of cardiovascular medications and trends in long-term prognosis after myocardial infarction (MI) in the elderly. Background: During the past decade, statins, beta-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin-II receptor blockers (ARBs) have been increasingly used after MI. However, little is known about the relationship between increasing use of these medications and improvements in prognosis after MI. Methods: Using data from pharmacy assistance programs and Medicare in 2 states (1995 to 2004), we identified patients with MI who survived ≥30 days after discharge. We assessed age, gender, race, comorbidities, and coronary interventions during the MI hospitalization and recorded filled prescriptions for statins, BBs, ACEIs/ARBs, or antiplatelet agents within 30 days after discharge. All patients were tracked until they died or until the end of the eligibility/study period. We built multivariate Cox proportional hazards regression models to assess trends in long-term mortality and the contribution to increasing medication use after MI. Results: Of 21,484 patients identified, 12,142 died during 74,982 person-years of follow-up. After adjusting for demographics and comorbidities, we found that mortality after MI decreased significantly from 1995 to 2004 (hazard ratio for annual trend 0.97; 95% confidence interval 0.97 to 0.98), a 3% reduction in mortality each year. Adjusting for the use of statins, BBs, ACEIs/ARBs, and antiplatelet drugs after discharge completely eliminated the association between time trend and mortality (hazard ratio 1.00; 95% confidence interval 0.99 to 1.01). Conclusions: The observed improvement in long-term mortality in elderly patients with MI may be mainly due to increased use of cardiovascular medications after discharge.

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