Background

Despite clear guideline recommendations for secondary prevention after a myocardial infarction (MI), blood pressure, cholesterol, and medication utilization may remain suboptimal after hospitalizations.

Methods

Observational cohort study of adults hospitalized for MI and discharged home between 2018-2022 with electronic health records in a US hospital system. Secondary prevention goals included low-density lipoprotein (LDL) < 70 mg/dL, systolic blood pressure (SBP) < 130 mmHg, and use of beta-blockers (BBs), statins, P2Y12 inhibitors, and renin-angiotensin-system inhibitors (RAS) measured during 12-months prior to admission, at discharge, and 12-months post-discharge. We tested changes before and 12-months after hospitalization in median LDL and SBP with Wilcoxon Signed-Rank tests and in use of medications with McNemar’s test.

Results

The cohort included 5265 patients hospitalized for an MI (age 68 [IQR 77-60] years, 39% female, 91% White, 7% Black). Prior to admission, 30% had an LDL at goal (median [IQR] 88 mg/dL [64-116]), 41% had an SBP at goal (133 mmHg [123-145]), and use of BBs was 31%, statins 19%, P2Y12 inhibitors 15%, and RAS 39% (Figure). At discharge, 36% met goal LDL and 61% met goal SBP, and use of BBs increased by 24 percentage points (pp), statins 21 pp, P2Y12 inhibitors 25 pp, and RAS 9 pp.

At 12 months post-discharge, median [IQR] LDL decreased to 63 mg/dL [46-83] and SBP decreased to 128 mmHg [118-140] and use of BBs was 54%, statins was 45%, P2Y12 inhibitors was 47%, and RAS was 38%. Compared to prior to admission, significant improvements in median LDL, median SBP, and use of BBs, statins, and P2Y12s, but not RAS, were observed at 12 months post-discharge (p<0.001). Thus, targets for LDL, SBP, and use of all four evidence-based medications were achieved at 12-months post-discharge for only 60%, 54%, and 16%, respectively.

Conclusions

One year following an MI hospitalization, many patients do not meet critical secondary prevention targets.