Temporal trends in secondary prevention in myocardial infarction patients discharged with left ventricular systolic
Mariusz Gasior1, Marek Gierlotka1, Łukasz Pyka1
11 3rd Department of Cardiology, Medical University of Silesia, Poland.
Insights
Patients with reduced ejection fraction after myocardial infarction show improving prognosis due to guideline-based care. However, suboptimal compliance with secondary prevention guidelines requires further attention.
Area of Science:
- Cardiology
- Public Health
- Clinical Research
Background:
- High rates of left ventricular systolic dysfunction post-myocardial infarction are linked to poor prognosis.
- Understanding temporal trends in treatment and outcomes is crucial for improving patient care.
Purpose of the Study:
- To analyze temporal trends in treatment and outcomes for patients discharged with left ventricular systolic dysfunction after myocardial infarction.
- To identify factors influencing prognosis in this high-risk population.
Main Methods:
- Utilized data from Polish national registries (Acute Coronary Syndromes and Acute Myocardial Infarction).
- Analyzed a cohort of 28,080 patients discharged with left ventricular ejection fraction ≤40%.
- Assessed temporal changes in interventions, cardiac rehabilitation, outpatient care, and 12-month composite outcomes.
Main Results:
- High implementation of guideline-based treatment at discharge.
- Increased use of percutaneous coronary intervention and implantable cardioverter-defibrillator/cardiac resynchronisation therapy defibrillator.
- Decreased rehospitalizations for myocardial infarction and a trend towards lower all-cause mortality.
- Significant decreasing trend in composite outcomes (death, MI, stroke, HF rehospitalization) at 12 months.
Conclusions:
- Overall prognosis for patients with myocardial infarction and reduced ejection fraction is slowly improving.
- Adherence to guideline-based secondary prevention strategies is likely contributing to better outcomes.
- Suboptimal compliance with outpatient cardiology specialist visits and cardiac rehabilitation necessitates targeted interventions.
Abstract:
Background The proportion of patients discharged after myocardial infarction with left ventricular systolic dysfunction remains high and the prognosis is unfavourable. The aim of this study was to analyse the temporal trends in the treatment and outcomes of a nationwide cohort of patients. Methods and results Data from the Polish Registry of Acute Coronary Syndromes and Acute Myocardial Infarction in Poland Registry were combined to achieve complete information on inhospital course, treatment and outcomes. An all-comer population of patients discharged with left ventricular ejection fraction of 40% or less formed the sample population ( n = 28,080). The patients were analysed for the incidence of significant temporal trends and their possible consequences. The implementation of guideline-based treatment at discharge was high. In the post-discharge course a trend towards a higher frequency of percutaneous coronary intervention and a lower prevalence of planned coronary artery bypass grafting procedures was observed. The number of implantable cardioverter defibrillator/cardiac resynchronisation therapy defibrillator implantations was increasing. Cardiac rehabilitation was performed in 19-23% cases. The post-discharge outpatient care was based on general practitioner visits, with only 47.9-48.1% of patients attending an ambulatory cardiology specialist visit. In 12 months of observation the frequency of heart failure rehospitalisations was 17.5-19.1%, while the prevalence of rehospitalisations due to myocardial infarction decreased (8.3% in 2009 to 6.7% in 2013, P < 0.001). A trend towards lower all-cause mortality was observed. Assessment of composite outcomes (death, myocardial infarction, stroke or heart failure rehospitalisation) adjusted for sex and age at 12 months revealed a significant decreasing trend. Conclusion The overall prognosis in this population is improving slowly. This may be due to the increasing prevalence of guideline-based forms of secondary prevention. Efforts aimed at maintaining these trends are essential, as overall compliance with these guideline remains suboptimal.
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