Utilization and discontinuation of secondary prevention pharmacotherapy after myocardial infarction: a nationwide cohort study
Authors' conclusion
Discontinuation of secondary preventive medications was common, but so was reinitiation. Thus, the proportion of patients with ongoing treatment was 91%-92% at 1 year and 74%-79% at 12 years after the MI. This study, which did not assess reasons for drug discontinuation, indicates that long-term utilization of secondary preventive medication after MI may not be as low as previously thought.
Study context
- Population
- Patients with a first-time myocardial infarction (MI) (2006–2021) registered in the nationwide Swedish MI register SWEDEHEART, surviving >30 days, and discharged with a new prescription of the drug (statins, beta-blockers, aspirin, renin-angiotensin-aldosterone system (RAAS) inhibitors; separate analyses for each drug)patients included in the analyses · discharged with a statin 122,288 · discharged with a RAAS inhibitor 79,968 · discharged with a beta-blocker 105,095 · discharged with aspirin 127,463
- Participants
- 159,155 patients
- Exposure
- Statin vs RAAS inhibitor vs beta-blocker vs aspirin
- Statinn = 122,288
- RAAS inhibitorn = 79,968
- Beta-blockern = 105,095
- Aspirinn = 127,463
- Outcome
- Filled first prescription for the drug
Main finding
As reported in the abstract
Proportion of patients who filled their first prescription
95%-97%
Observational data: associations, not effects.
Further findings
Treatment discontinuation (≥90-day period of non-treatment after the end of previous prescriptions), range across drugs · 1, 5 and 12 years
- 1 year
- 12% to 14%
- 5 years
- 27%-37%
- 12 years
- 36%-51%
Reinitiation among those who discontinued treatment, range across drugs · 1, 5 and 12 years after discontinuation
- 1 year
- 28%-46%
- 5 years
- 42%-62%
- 12 years
- 47%-67%
- Among those who discontinued treatment
Alive with ongoing treatment (regardless of previous discontinuation/reinitiation episodes) · 1, 5 and 12 years after the index MI
- 1 year
- 91%-92%
- 5 years
- 79%-82%
- 12 years
- 74%-79%
Original publication
Summarised from the published abstract; every number is checked against it