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

摘要

Background Both the incidence of myocardial infarction (Ml) and short-term case fatality have declined in the UK. However, little is known about trends in longer-term survival following an Ml. The aim of the study was to investigate trends in longer-term survival, alongside trends in medication prescribing in primary care. Methods Data 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 Ml between 1991 and 2002 and had already survived 3 months. Results Adjusting for age and gender, the 3-year post-Mi case-fatality rate among 3-month survivors fell by 28% (95% Cl 13 to 40), from 83 deaths per 1000 person years for Ml occurring in 1991—2 to 61 deaths per 1000 person-years for Ml 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 Ml 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%. Conclusion There has been a moderate improvement in longer-term survival following an Ml, 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.