Changes in the use of medications after acute myocardial infarction: possible impact on mortality after myocardial infarction and long-term outcome

Objective To describe the change in the use of medication after acute myoca rdial infarction (AMI) and discuss its possible impact on risk and risk ind icators for death. Patients All patients discharged alive after hospitalization for AMI at Sah lgrenska Hospital (covering half the community of Goteborg, i.e. 250 000 of 500 000 inhabitants) during 1986-1987 (period I) and at Sahlgrenska Hospit al and Ostra Hospital (covering the whole community of Goteborg, 500 000 in habitants) during 1990-1991 (period II). Methods Overall mortality was retrospectively evaluated during 5 years of f ollow-up. Results In all, 740 patients were included in the study during period I and 1448 during period II. The 5-year mortalities were 44.1% for period I pati ents and 39.3% for period II patients (P = 0.036). The relative risk of dea th for period II patients was 0.78 [95% confidence interval (CI) 0.67-0.89, P = 0.0005] after adjustment for differences at baseline. There was a sign ificant interaction with a history of congestive heart failure; improvement in duration of survival was found only for patients without such a history . During period I, only 3% of patients were administered fibrinolytic agent s, compared with 33% of patients during period II (P < 0.0001). During peri od I, aspirin was prescribed for 13% of patients discharged from hospital c ompared with 79% during period II. Other changes in treatment on going from period I to period II included increases in prescription of <beta>-blocker s and angiotensin converting enzyme inhibitors. After adjustment for variou s risk indicators for death, relative risk of death for those administered fibrinolytic agents was 0.60 (95% CI 0.18 -2.02) for patients in the period -I cohort and 0.68% (95% CI 0.51-0.91) for those in the period-II cohort. A djusted relative risk of death for those prescribed aspirin upon discharge from hospital was 0.81 (95% CI 0.52-1.25) for period-I patients and 0.71 (9 5% CI 0.56-0.91) for period-II patients. The adjusted relative risk of deat h for those administered beta -blockers was 0.72 (95% CI 0.55-0.96) for per iod-I patients and 0.70 (95% CI 0.55-0.90) for period-II patients. Conclusion Increased use of fibrinolytic agents and aspirin for AMI as well as a moderate increase in use of beta -blockers and angiotensin converting enzyme inhibitors was associated with a parallel reduction in age-adjusted mortality during the 5 years after discharge from hospital. However, this improvement was seen only for patients without histories of congestive hear t failure. Coron Artery Dis 12:61-67 (C) 2001 Lippincott Williams & Wilkins .