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Background: Medication adherence is important to improve the long-term outcomes after acute myocardial infarction (MI). We hypothesized that there is significant variation among US hospitals in terms of medication adherence after MI, and that patients treated at hospitals with higher medication adherence after MI will have better long-term cardiovascular outcomes. Methods: We identified 19 704 Medicare patients discharged after acute MI from 347 US hospitals participating in the ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines) from January 2, 2007, to October 1, 2010. Using linked Medicare Part D prescription filling data, medication adherence was defined as proportion of days covered >80% within 90 days after discharge. Cox proportional hazards modeling was used to compare 2-year major adverse cardiovascular events among hospitals with high, moderate, and low 90-day medication adherence. Results: By 90 days after MI, overall rates of adherence to medications prescribed at discharge were 68% for β-blockers, 63% for statins, 64% for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 72% for thienopyridines. Adherence to these medications up to 90 days varied significantly among hospitals: β-blockers (proportion of days covered >80%; 59% to 75%), statins (55% to 69%), thienopyridines (64% to 77%), and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (57% to 69%). Compared with hospitals in the lowest quartile of 90-day composite medication adherence, hospitals with the highest adherence had lower unadjusted and adjusted 2-year major adverse cardiovascular event risk (27.5% versus 35.3%; adjusted hazard ratio, 0.88; 95% confidence interval, 0.80–0.96). High-adherence hospitals also had lower adjusted rates of death or readmission (hazard ratio, 0.90; 95% confidence interval, 0.85–0.96), whereas there was no difference in mortality after adjustment. Conclusions: Use of secondary prevention medications after discharge varies significantly among US hospitals and is inversely associated with 2-year outcomes. Hospitals may improve medication adherence after discharge and patient outcomes through better coordination of care between inpatient and outpatient settings.

Over the past decade, more men than women have shown improved outcomes from antithrombotic therapies after acute coronary syndrome (ACS), which raises the question of whether there are sex-specific differences in treatment patterns and response to therapy. Differences in presenting clinical characteristics, pathophysiologic profile, and disparities in treatment may contribute to this outcomes discrepancy. Analyses of large trials and registry data suggest that male and female ACS patients experience similar benefits from antithrombotic therapy without significant difference in treatment utilization rates, yet women are consistently at higher risk of bleeding than men. Bleeding may result in antithrombotic treatment disruption, which increases the risk of long-term thrombotic events. Additionally, female ACS patients are more likely to receive suboptimal medication dosing and have lower rates of long-term medication adherence. These differences have significant clinical implications for women, indicating the need for strategies that will optimize initial treatment and long-term management attuned to these recognized sex-specific gaps.

Background: The 2013 ACC/AHA cholesterol guidelines recommend high intensity statin use for all post-myocardial infarction (MI) patients, instead of treating to a low density lipoprotein cholesterol (LDL-C) goal on follow-up lipid testing. We examined whether high intensity statin use was common in U.S. practice prior to these guideline updates. Methods: We linked the ACTION Registry-GWTG to Medicare data and evaluated 11,046 post-MI patients aged ≥65 years discharged alive on a statin from 347 hospitals between 2007 and 2009. Rates and dosing of lipid therapy as well as follow-up lipid testing within 90 days after discharge were studied. Multivariable logistic regression was used to evaluate the association of lipid testing with 1-year statin use and intensity. Results: Only 21% of MI patients were discharged on a high intensity statin. By 90 days post-MI, 44% (n=4,884) of patients underwent lipid testing. Among patients discharged on low/moderate intensity statins, 43% underwent lipid testing within the next 90 days, and 49% of patients discharged on high intensity statins received lipid testing within 90 days. Rates of lipid testing did not differ substantially between patients with LDL-C ≥100 mg/dL vs. Conclusion: Prior to the 2013 ACC/AHA cholesterol guideline updates, only 1 in 5 MI patients were discharged on high intensity statin therapy. Although follow-up lipid testing was associated with both higher rates of statin persistence to one year and increased likelihood of statin intensification, it was performed in only a minority of patients. The new cholesterol guidelines may promote more aggressive lipid management and cardiovascular risk reduction by eliminating treatment dependence on follow-up lipid testing.

While ezetimibe has been approved for lipid lowering in the U.S. since 2002, the IMPROVE-IT trial only recently demonstrated its benefit on clinical outcomes when added to a statin in post-myocardial infarction (MI) patients. We examined patterns of ezetimibe and statin combination therapy use at