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Combination evidence-based therapy is effective in the oldest 'old patients' following myocardial infarction. The "Salute e Benessere nell'Anziano" (SeBA) observational study.
Intern Emerg Med. 2016 Feb 3;
Authors: Di Bari M, Esposti LD, Veronesi C, Pecorelli S, Fini M, Baldasseroni S, Mossello E, Fumagalli S, Scatigna M, Marchionni N
Abstract
Antiplatelet drugs, statins, angiotensinogen-converting enzyme inhibitors or angiotensin-II receptor blockers, and β-blockers improve survival following myocardial infarction (MI). However, in old age they are under-prescribed, and their effectiveness in combination regimens is unproven. The aim of the study was to evaluate prescription of recommended cardiovascular drug classes and impact of a combination regimen on long-term mortality and hospitalizations. Records of 65+ years MI survivors, discharged from hospitals in four Local Health Units in Italy, were selected from administrative databases and analyzed. All-cause mortality and cardiovascular re-hospitalization in 12 months were compared across participants prescribed 0, 1, 2, 3, or 4 recommended drug classes. Out of 2626 participants (56 % men, 25 % aged 85+ years), 42 % were prescribed all, 14 % none of the recommended drug classes. The prescription rate decreased with advancing age. At all ages, mortality decreased with increasing number of drug classes prescribed: in participants aged 85+ years, adjusted hazard ratios (95 % confidence interval) for death were 0.74 (0.47-1.17), 0.52 (0.33-0.82), 0.30 (1.19-0.48), and 0.33 (0.20-0.53) for 1, 2, 3, and 4 classes prescribed, compared with none. The risk of cardiovascular re-hospitalizations decreased with an increasing number of drug classes prescribed through the age of 84 years. After MI, a combination regimen of recommended drug classes prevents long-term mortality at any age, and cardiovascular re-hospitalizations through the age of 84. Enhancing compliance with treatment guidelines may reduce the burden of mortality and hospitalizations in older MI survivors.
PMID: 26843198 [PubMed - as supplied by publisher]