Long-term secondary prevention of acute myocardial infarction (SEPAT) - guidelines adherence and outcome
Constantinos Ergatoudes1, Erik Thunström1, Annika Rosengren1
1Department of Molecular and Clinical Medicine, Institute of Medicine, Skövde, Sweden.
Insights
Long-term cardiovascular prevention after acute myocardial infarction (AMI) is often suboptimal. This study reveals poor guideline adherence and a high rate of adverse events two years post-AMI, highlighting a failure in clinical practice.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Practice Research
Background:
- Registry studies indicate suboptimal cardiovascular prevention adherence in the first year post-acute myocardial infarction (AMI).
- Long-term secondary prevention strategies after AMI remain under-addressed in research.
- This study assesses guideline adherence and outcomes of secondary prevention two years after AMI.
Purpose of the Study:
- To evaluate adherence to secondary prevention guidelines in patients surviving two years after AMI.
- To assess the outcomes of guideline-directed secondary prevention in this patient cohort.
- To identify gaps in clinical practice for long-term cardiovascular risk management post-AMI.
Main Methods:
- A cohort of 200 patients aged 18-85 years, surviving two years post-index AMI, was identified from hospital records in Gothenburg, Sweden.
- Participants underwent structured interviews, physical examinations, and laboratory analyses.
- Guideline adherence was defined by achieving targets for blood pressure, cholesterol, glucose, physical activity, smoking cessation, and medication.
Main Results:
- Only 3.5% of patients achieved all six secondary prevention goals two years post-AMI.
- Optimal LDL cholesterol (<1.8 mmol/L) was achieved by 18.5%, regular exercise by 45.5%, and systolic blood pressure (<140 mmHg) by 57.0%.
- High rates of non-fatal adverse cardiovascular events (47%) and cardiac readmissions (30%) occurred during follow-up.
Conclusions:
- Secondary prevention efforts following AMI demonstrate significant failures in current clinical practice.
- A high incidence of non-fatal adverse cardiovascular events necessitates improved long-term management strategies post-AMI.
- The findings underscore the urgent need for enhanced adherence to cardiovascular prevention guidelines in patients with a history of AMI.
Background:
A number of registry studies have reported suboptimal adherence to guidelines for cardiovascular prevention during the first year after acute myocardial infarction (AMI). However, only a few studies have addressed long-term secondary prevention after AMI. This study evaluates prevention guideline adherence and outcome of guideline-directed secondary prevention in patients surviving 2 years after AMI.
Methods:
Patients aged 18-85 years at the time of their index AMI were consecutively identified from hospital discharge records between July 2010 and December 2011 in Gothenburg, Sweden. All patients who agreed to participate in the study (16.2%) were invited for a structured interview, physical examinations and laboratory analysis 2 years after AMI. Guideline-directed secondary preventive goals were defined as optimally controlled blood pressure, serum cholesterol, glucose, regular physical activity, smoking cessation and pharmacological treatment.
Results:
The mean age of the study cohort (n = 200) at the index AMI was 63.0 ± 9.7 years, 79% were men. Only 3.5% of the cohort achieved all six guideline-directed secondary preventive goals 2 years after infarction. LDL < 1.8 mmol/L was achieved in 18.5% of the cohort, regular exercise in 45.5% and systolic blood pressure <140 mmHg in 57.0%. Anti-platelet therapy was used by 97% of the patients, beta-blockers by 83.0%, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers by 76.5% and statins by 88.5%. During follow-up, non-fatal adverse cardiovascular events (cardiac hospitalization, recurrent acute coronary syndrome, angina pectoris, new percutaneous coronary intervention, new onset of atrial fibrillation, post-infarct heart failure, pacemaker implantation, stroke/transient ischemic attack (TIA), cardiac surgery and cardiac arrest) occurred in 47% of the cohort and readmission due to cardiac causes in 30%.
Conclusions:
Our data showed the failure of secondary prevention in our daily clinical practice and high rate of non-fatal adverse cardiovascular events 2 years after AMI.
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