Use of aspirin, beta-blockers, and lipid-lowering medications before recurrent acute myocardial infarction - Missed opportunities for prevention?

Background: For patients who have had a previous myocardial infarction (MI) , the use of aspirin, beta-blockers, and lipid-lowering agents reduces the risk of recurrent MI and death. Objective: To examine trends in and determinants of receipt of these 3 medi cations before hospitalization for recurrent acute MI (AMI). Methods: The study population consisted of 1710 patients with a previous hi story of MI hospitalized with a validated recurrent AMI in all hospitals in Worcester, Mass, during 1986, 1988, 1990, 1991, 1993, and 1995. Logistic r egression analyses were used to assess the effect of demographic, clinical, and temporal factors on the receipt of aspirin, beta-blockers, and lipid-l owering medications before hospital admission for recurrent AMI. Results: More than 47% of patients in each study year were not receiving ea ch medication before admission, although significant increases in use were noted over time for aspirin (from 13.5% to 52.6%), beta-blockers (from 33.2 % to 44.4%), and lipid-lowering medications (from 0.8% to 11.7%). In multiv ariate analyses, advancing age was associated with not receiving aspirin (o dds ratio [OR], 0.67; 95% confidence interval [CI], 0.51-0.89), lipid-lower ing medications (OR, 0.14; 95% CI, 0.08-0.25), and beta-blockers (OR, 0.75; 95% CI, 0.57-1.00),although this effect was of borderline significance for beta-blockers. Being a woman was associated with not receiving aspirin (OR , 0.78; 95% CI, 0.62-0.98) but was positively associated with receiving lip id-lowering medications (OR, 1.59, 95% CI, 1.04-2.43). Coexisting medical c onditions and concurrent use of other cardiovascular medications were also associated with receipt of each medication. Conclusion: Despite encouraging increases over time, the low absolute level s of receipt of medications shown to be efficacious in the long-term treatm ent of patients after an MI, and their variation by age and sex, suggest th at substantial opportunities may exist to prevent recurrent AMIs through th e increased use of aspirin, beta-blockers, and lipid-lowering medications.