Part of this work was presented as a poster at the EuroEPI conference (2010) and at the IEA World Congress of Epidemiology 2011.
Effect of evidence-based drug therapy on long-term outcomes in patients discharged after myocardial infarction: a nested case–control study in Italy
Version of Record online: 26 MAR 2013
Copyright © 2013 John Wiley & Sons, Ltd.
Pharmacoepidemiology and Drug Safety
Volume 22, Issue 6, pages 649–657, June 2013
How to Cite
Kirchmayer, U., Di Martino, M., Agabiti, N., Bauleo, L., Fusco, D., Belleudi, V., Arcà, M., Pinnarelli, L., Perucci, C. A. and Davoli, M. (2013), Effect of evidence-based drug therapy on long-term outcomes in patients discharged after myocardial infarction: a nested case–control study in Italy. Pharmacoepidem. Drug Safe., 22: 649–657. doi: 10.1002/pds.3430
Ethical approval: According to the regional law in Italy, the present study, which was based on anonymous computer records from health information systems, did not require ethical approval.
This article was published online on March 26, 2013. Error in one of the author names was subsequently identified. This notice is included in the online and print versions to indicate that both have been corrected [April 17, 2013].
- Issue online: 4 JUN 2013
- Version of Record online: 26 MAR 2013
- Manuscript Accepted: 4 FEB 2013
- Manuscript Revised: 17 JAN 2013
- Manuscript Received: 20 SEP 2012
There are some methodological concerns regarding results from observational studies about the effectiveness of evidence-based (EB) drug therapy in secondary prevention after myocardial infarction. The present study used a nested case–control approach to address these major methodological limitations.
A cohort of 6880 patients discharged from hospital after acute myocardial infarction (AMI) in 2006–2007 was enrolled and followed-up throughout 2009. Exposure was defined as adherence to each drug in terms of the proportion of days covered (cutoff ≥ 75%). Composite treatment groups, that is, groups with no EB therapy or therapy with one, two, three, or four EB drugs), were analyzed. Outcomes were overall mortality and reinfarction. Nested case–control studies were performed for both outcomes, matching four controls to every case (841 deaths, 778 reinfarctions) by gender, age, and individual follow-up. The association between exposure to EB drug therapy and outcomes was analyzed using conditional logistic regression, adjusting for revascularization procedures, comorbidities, duration of index admission, and use of the study drugs prior to admission.
Mortality and reinfarction risk decreased with the use of an increasing number of EB drugs. Combinations of two or more EB drugs were associated with a significant protective effect (p < 0.001) versus no EB drugs (mortality: 4 EB drugs: ORadj = 0.35; 95%CI: 0.21–0.59; reinfarction: 4 EB drugs: ORadj = 0.23; 95%CI: 0.15–0.37).
These findings of the beneficial effects of EB polytherapy on mortality and morbidity in a population-based setting using a nested case–control approach strengthen existing evidence from observational studies. Copyright © 2013 John Wiley & Sons, Ltd.