Care pathway in patients after myocardial infarction in Denmark - healthcare and drug utilization
Marius Mølsted Flege1, Theresa Kleinschmidt1, Susanne Hansen1
1Copenhagen Phase IV Unit (Phase4CPH), Department of Clinical Pharmacology and Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
Insights
Many patients do not receive adequate lipid-lowering therapy or monitoring one year after myocardial infarction (MI). This highlights a need for improved follow-up of low-density lipid cholesterol (LDL-C) levels and healthcare visits post-MI to prevent recurrent cardiovascular events.
Area of Science:
- Cardiology
- Public Health
- Pharmacotherapy
Background:
- Post-myocardial infarction (MI) care guidelines recommend lowering low-density lipid cholesterol (LDL-C) and cardiac rehabilitation.
- Many patients fail to achieve target LDL-C levels, increasing the risk of recurrent cardiovascular events.
- Effective follow-up and lipid-lowering therapy (LLT) are crucial for secondary prevention after MI.
Purpose of the Study:
- To investigate the one-year follow-up of LDL-C levels and the utilization of LLT in patients post-MI.
- To identify factors associated with follow-up and LLT adherence after myocardial infarction.
Main Methods:
- A nationwide Danish observational study using register data.
- Inclusion of all patients hospitalized with incident MI from 2018 to 2021, discharged alive.
- One-year follow-up assessing LDL-C measurements, healthcare contacts, and LLT redemption.
Main Results:
- 87% of patients had at least one LDL-C measurement, and 67% had two within one year.
- Statin therapy was redeemed by 87% of patients at least once, with ezetimibe and other drugs used less frequently.
- Younger, higher-educated males with higher baseline LDL-C were more likely to receive follow-up care.
Conclusions:
- A significant proportion of patients are not monitored or treated according to guidelines one year after MI.
- There is a need for enhanced monitoring of LDL-C levels and healthcare visits for MI patients.
- Optimizing LLT and follow-up strategies is essential for reducing long-term cardiovascular risk.
Background:
Following myocardial infarction (MI), patients are recommended to lower their low-density lipid cholesterol (LDL-C) levels and undergo cardiac rehabilitation to prevent recurrent events. Although lowering LDL-C is vital post-MI, many patients fail reaching sufficient levels, resulting in recurrent cardiovascular events. The aim of the study was therefore to investigate the follow-up and the utilisation of lipid lowering therapy one year after MI.
Methods:
This register-based nationwide Danish observational study included all hospitalized patients with an incident MI from 2018 to 2021, discharged alive. Patients were followed for one year after discharge with respect to LDL-C measurements, contacts with different healthcare actors, and lipid lowering therapy.
Results:
A total of 24,977 patients were included. During follow-up, the incidence of having an LDL-C measured once and twice were 87 % and 67 %, respectively. The incidence of patients visiting a cardiology department, general practitioner with an LDL-C measurement, and having an acute hospital contact were 66 %, 70 %, and 48 %. Statin therapy was redeemed by most patients at least once (87 %) or twice (82 %), while ezetimibe (16 %) and other drugs were prescribed less frequently. Younger, higher educated, less comorbid males with LDL-C ≥ 1.4 mmol/L at hospitalization were more likely to be followed-up with LDL-C measurement or visit to a cardiology department post-MI.
Conclusion:
These findings show that a large proportion of patients are not receiving lipid lowering therapy or are not monitored according to guidelines one year after an MI. This suggests a further need for monitoring MI patients with LDL-C levels and healthcare visits.
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