Combination evidence-based therapy is effective in the oldest ‘old patients’ following myocardial infarction. The “Salute e Benessere nell’Anziano” (SeBA) observational study

Mauro Di Bari, Luca Degli Esposti, Chiara Veronesi, Sergio Pecorelli, Massimo Fini, Samuele Baldasseroni, Enrico Mossello, Stefano Fumagalli, Marco Scatigna, Niccolò Marchionni

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Antiplatelet drugs, statins, angiotensinogen-converting enzyme inhibitors or angiotensin-II receptor blockers, and β-blockers improve survival following myocardial infarction (MI). However, in old age they are under-prescribed, and their effectiveness in combination regimens is unproven. The aim of the study was to evaluate prescription of recommended cardiovascular drug classes and impact of a combination regimen on long-term mortality and hospitalizations. Records of 65+ years MI survivors, discharged from hospitals in four Local Health Units in Italy, were selected from administrative databases and analyzed. All-cause mortality and cardiovascular re-hospitalization in 12 months were compared across participants prescribed 0, 1, 2, 3, or 4 recommended drug classes. Out of 2626 participants (56 % men, 25 % aged 85+ years), 42 % were prescribed all, 14 % none of the recommended drug classes. The prescription rate decreased with advancing age. At all ages, mortality decreased with increasing number of drug classes prescribed: in participants aged 85+ years, adjusted hazard ratios (95 % confidence interval) for death were 0.74 (0.47–1.17), 0.52 (0.33–0.82), 0.30 (1.19–0.48), and 0.33 (0.20–0.53) for 1, 2, 3, and 4 classes prescribed, compared with none. The risk of cardiovascular re-hospitalizations decreased with an increasing number of drug classes prescribed through the age of 84 years. After MI, a combination regimen of recommended drug classes prevents long-term mortality at any age, and cardiovascular re-hospitalizations through the age of 84. Enhancing compliance with treatment guidelines may reduce the burden of mortality and hospitalizations in older MI survivors.

Original languageEnglish
Pages (from-to)1-9
Number of pages9
JournalInternal and Emergency Medicine
DOIs
Publication statusAccepted/In press - Feb 3 2016

Fingerprint

Observational Studies
Hospitalization
Myocardial Infarction
Mortality
Pharmaceutical Preparations
Prescriptions
Survivors
Therapeutics
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiovascular Agents
Angiotensinogen
Angiotensin Receptor Antagonists
Platelet Aggregation Inhibitors
Enzyme Inhibitors
Italy
Databases
Guidelines
Confidence Intervals
Survival
Health

Keywords

  • Administrative databases
  • Coronary artery disease
  • Drug treatment
  • Elderly

ASJC Scopus subject areas

  • Emergency Medicine
  • Internal Medicine

Cite this

Combination evidence-based therapy is effective in the oldest ‘old patients’ following myocardial infarction. The “Salute e Benessere nell’Anziano” (SeBA) observational study. / Di Bari, Mauro; Esposti, Luca Degli; Veronesi, Chiara; Pecorelli, Sergio; Fini, Massimo; Baldasseroni, Samuele; Mossello, Enrico; Fumagalli, Stefano; Scatigna, Marco; Marchionni, Niccolò.

In: Internal and Emergency Medicine, 03.02.2016, p. 1-9.

Research output: Contribution to journalArticle

Di Bari, Mauro ; Esposti, Luca Degli ; Veronesi, Chiara ; Pecorelli, Sergio ; Fini, Massimo ; Baldasseroni, Samuele ; Mossello, Enrico ; Fumagalli, Stefano ; Scatigna, Marco ; Marchionni, Niccolò. / Combination evidence-based therapy is effective in the oldest ‘old patients’ following myocardial infarction. The “Salute e Benessere nell’Anziano” (SeBA) observational study. In: Internal and Emergency Medicine. 2016 ; pp. 1-9.
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abstract = "Antiplatelet drugs, statins, angiotensinogen-converting enzyme inhibitors or angiotensin-II receptor blockers, and β-blockers improve survival following myocardial infarction (MI). However, in old age they are under-prescribed, and their effectiveness in combination regimens is unproven. The aim of the study was to evaluate prescription of recommended cardiovascular drug classes and impact of a combination regimen on long-term mortality and hospitalizations. Records of 65+ years MI survivors, discharged from hospitals in four Local Health Units in Italy, were selected from administrative databases and analyzed. All-cause mortality and cardiovascular re-hospitalization in 12 months were compared across participants prescribed 0, 1, 2, 3, or 4 recommended drug classes. Out of 2626 participants (56 {\%} men, 25 {\%} aged 85+ years), 42 {\%} were prescribed all, 14 {\%} none of the recommended drug classes. The prescription rate decreased with advancing age. At all ages, mortality decreased with increasing number of drug classes prescribed: in participants aged 85+ years, adjusted hazard ratios (95 {\%} confidence interval) for death were 0.74 (0.47–1.17), 0.52 (0.33–0.82), 0.30 (1.19–0.48), and 0.33 (0.20–0.53) for 1, 2, 3, and 4 classes prescribed, compared with none. The risk of cardiovascular re-hospitalizations decreased with an increasing number of drug classes prescribed through the age of 84 years. After MI, a combination regimen of recommended drug classes prevents long-term mortality at any age, and cardiovascular re-hospitalizations through the age of 84. Enhancing compliance with treatment guidelines may reduce the burden of mortality and hospitalizations in older MI survivors.",
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