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European Heart Journal Advance Access originally published online on January 6, 2006
European Heart Journal 2006 27(10):1153-1158; doi:10.1093/eurheartj/ehi705
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© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Long-term compliance with beta-blockers, angiotensin-converting enzyme inhibitors, and statins after acute myocardial infarction

Gunnar H. Gislason1,2,*, Jeppe N. Rasmussen2, Steen Z. Abildstrøm2,3, Niels Gadsbøll4, Pernille Buch1,2, Jens Friberg1, Søren Rasmussen2, Lars Køber5, Steen Stender6, Mette Madsen2 and Christian Torp-Pedersen1

1 Department of Cardiovascular Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen NV, Denmark
2 National Institute of Public Health, Copenhagen, Denmark
3 Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
4 Department of Internal Medicine, Roskilde County Hospital, Roskilde, Denmark
5 Department of Cardiology, The Heart Centre, Rigshospitalet—National University Hospital, Copenhagen, Denmark
6 Clinical Biochemistry, Gentofte University Hospital, Hellerup, Denmark

Received 10 October 2005; revised 5 December 2005; accepted 8 December 2005; online publish-ahead-of-print 6 January 2006.

* Corresponding author. Tel: +45 3531 3328; fax: +45 3975 1803. E-mail address: gg{at}heart.dk

Aims To study initiation, dosages, and compliance with beta-blockers, angiotensin-converting enzyme (ACE)-inhibitors, and statins in patients after acute myocardial infarction (AMI) and to identify likely targets for improvement.

Methods and results Patients admitted with first AMI between 1995 and 2002 were identified by linking nationwide administrative registers. A total of 55 315 patients survived 30 days after discharge and were included; 58.3% received beta-blockers, 29.1% ACE-inhibitors, and 33.5% statins. After 1, 3, and 5 years, 78, 64, and 58% of survivors who had started therapy were still receiving beta-blockers, 86, 78, and 74% were receiving ACE-inhibitors, and 85, 80, and 82% were receiving statins, respectively. Increased age and female sex were associated with improved compliance. The dosages prescribed were generally 50% or less of the dosages used in clinical trials, and dosages did not increase during the observation period. Patients who did not start treatment shortly after discharge had a low probability of starting treatment later.

Conclusion The main problem with underuse of recommended treatment after AMI is that treatment is not initiated at an appropriate dosage shortly after AMI. A focused effort in the immediate post-infarction period would appear to provide long-term benefit.

Key Words: Acute myocardial infarction • Beta-blockers • ACE-inhibitors • Statins • Pharmacological treatment • Compliance


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