Trends in longer-term survival following an acute myocardial infarction and prescribing of evidenced-based medications in primary care in the UK from 1991: a longitudinal population-based study

• Published in: Journal of epidemiology and community health (1979) 2011-09, Vol.65 (9), p.770-774
• Main Authors: Hardoon, Sarah L, Whincup, Peter H, Petersen, Irene, Capewell, Simon, Morris, Richard W
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Age; Age Factors; Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular disease; Codes; Coronary artery disease; Coronary heart disease; Death; Drug Utilization Review; Drugs; Evidence-Based Medicine; evidenced-based medicine; Fatalities; Female; Gender; General aspects; General practice; Heart; Heart attacks; Hospitals; Humans; Hypolipidemic Agents - therapeutic use; Incidence; longer-term survival; Longitudinal Studies; Male; Medical diagnosis; Medical sciences; Medications; Men; Middle Aged; Miscellaneous; Mortality; Myocardial infarction; Myocardial Infarction - drug therapy; Myocardial Infarction - epidemiology; Patients; population; Population studies; Prescription drugs; Prescriptions; Primary care; Primary health care; Primary Health Care - statistics & numerical data; Public health. Hygiene; Public health. Hygiene-occupational medicine; Research Report; secondary prevention; Sex Factors; Survival; Survival Analysis; Time Factors; time trends; Trends; United Kingdom - epidemiology
• ISSN: 0143-005X; 1470-2738
• DOI: 10.1136/jech.2009.098087

BackgroundBoth the incidence of myocardial infarction (MI) and short-term case fatality have declined in the UK. However, little is known about trends in longer-term survival following an MI. The aim of the study was to investigate trends in longer-term survival, alongside trends in medication prescribing in primary care.MethodsData came from 218 general practices contributing to the Health Improvement Network, a UK-wide primary care database. 3-year survival and medication use were determined for 6586 men and 3766 women who had an MI between 1991 and 2002 and had already survived 3 months.ResultsAdjusting for age and gender, the 3-year post-MI case-fatality rate among 3-month survivors fell by 28% (95% CI 13 to 40), from 83 deaths per 1000 person-years for MI occurring in 1991–2 to 61 deaths per 1000 person-years for MI in 2001–2. Relative declines in the case-fatality rate of 37% (20 to 50) and 14% (−11 to 34) were observed for men and women, respectively (p=0.06 for interaction). Prescribing in the 3 months following the MI of lipid-regulating drugs increased from 3% of patients in 1991 to 79% in 2002, prescribing of beta-blockers increased from 26% to 68%, prescribing of ACE inhibitors increased from 11% to 71% and prescribing of anti-platelet medication increased from 46% to 86%.ConclusionThere has been a moderate improvement in longer-term survival following an MI, distinct from improvements in short-term survival, although men may have benefited more than women. Increased medication prescribing in primary care may be a contributing factor.