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13. Jahrestagung der Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie

02.11. bis 03.11.2006, Berlin

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Adherence to guideline based therapy has led to a reduction of hospital mortality in patients with myocardial infarction: results of the Berlin Myocardial Infarction Registry from 1999 - 2004

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  • corresponding author B. Maier - Interdisciplinary Network for Epidemiological Research in Berlin (EpiBerlin), TU Berlin
  • W. Thimme - Berliner Herzinfarktregister, Berlin
  • R. Schoeller - DRK Kliniken Westend, Berlin
  • A. Fried - Gemeinschaftskrankenhaus Havelhöhe, Berlin
  • S. Behrens - Vivantes Humboldt Klinikum und Vivantes Klinikum Spandau, Berlin
  • H. Theres - Universitätsklinikum Charité Campus Mitte, Berlin

Gesellschaft für Arzneimittelanwendungsforschung und Arzneimittelepidemiologie e.V. (GAA). 13. Jahrestagung der Gesellschaft für Arzneimittelforschung und Arzneimittelepidemiologie. Berlin, 02.-03.11.2006. Düsseldorf: German Medical Science GMS Publishing House; 2006. Doc06gaa15

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/gaa2006/06gaa15.shtml

Published: October 30, 2006

© 2006 Maier et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

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Context: Guidelines for treatment of patients with myocardial infarction (MI) have been regularly updated. In addition, a new definition for acute MI has been recently established.

Aim of the study: The aim of our study was to evaluate development of treatment and effects on patient outcome.

Material and Method: We prospectively collected data from 6080 consecutive MI patients presenting with (STEMI, n = 4314) and without persistent ST-segment elevation (NSTEMI, n = 1766) who were treated in 22 hospitals in Berlin between 1999 and 2004.

Results: Over time NSTEMI and STEMI patients showed an increase in arterial hypertension, smoking, hypercholesterolemia, history of congestive heart failure and renal failure. Upon admission STEMI patients presented with overt heart failure more frequently in recent years. The use of acute PCI increased from 15.3% to 62.3% (p<0.001) for NSTEMI patients and from 24.7% to 71.8% (p<0.001) for STEMI patients. Concomitant therapy with beta-blockers (NSTEMI: 68.1% vs. 90.8% (p<0.001); STEMI: 68.5% vs. 89.5% (p<0.001)), ACE-inhibitors (NSTEMI: 49.5% vs. 69.2% (p<0.001); STEMI: 45.8% vs. 71.6% (p<0.001)), Statines (NSTEMI: 30.5% vs. 72.9% (p<0.001); STEMI: 32.8% vs. 71.4% (p<0.001)), GP IIb/IIIa (NSTEMI: 12.3% vs. 43.7% (p<0.001); STEMI: 16.1% vs. 53.3% (p<0.001)) and Aspirin (NSTEMI: 89.7% vs. 97.0% (p<0.001); STEMI: 91.8% vs. 98.0% (p<0.001)) increased in a parallel manner in both groups. Hospital mortality decreased more pronounced for NSTEMI patients (13.5% vs 4.6% (p<0.001)) compared to STEMI patients (13.0% vs. 9.4% (p=0.005)). In 2004 recommended discharge medication was provided on a high level for both groups of patients (ASA >96%, beta-blockers >90%, ace-inhibitors >80%, statines >85%). Over time it increased similarly to concomitant therapy.

Conclusion: Adherence to guidelines has lead to a high level of hospital care for NSTEMI and STEMI patients. Consequently hospital mortality decreased for both groups, with a greater impact in NSTEMI patients.