Drug prescriptions after acute myocardial infarction: dosage, compliance, and persistence

Am Heart J. 2003 Mar;145(3):438-44. doi: 10.1067/mhj.2003.143.


Background: Although it has been well documented that aspirin, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and lipid-lowering drugs are under-prescribed for patients with acute myocardial infarction (Am Heart J 2003;145:438-44.), few studies have examined dosage and long-term compliance and persistence patterns for the use of these drugs after AMI.

Methods: Using Quebec administrative data on all elderly (aged > or =65 years) survivors of hospital admissions for AMI between 1996 and 1998 (n = 14,057), we studied the discharge prescriptions, dosages, patient compliance, and persistence during this period for aspirin, beta-blockers, ACE inhibitors, and lipid-lowering drugs.

Results: Rates of discharge medications were suboptimal (aspirin 65%, beta-blockers 54%, ACE inhibitors 45%, lipid-lowering drugs 21%). Most patients with prescriptions for aspirin and ACE inhibitors were prescribed dosages equivalent to those administered in clinical trials (99% and 88%, respectively). In contrast, only 20% of patients with beta-blocker prescriptions and 48% of patients with lipid-lowering drug prescriptions were prescribed clinical trial doses. For patients with discharge prescriptions, 1-year compliance rates were high (aspirin 74%, beta-blockers 74%, ACE inhibitors 70%, lipid-lowering drugs 84%), as were the 1-year persistence rates (aspirin 71%, beta-blockers 72%, ACE inhibitors 69%, lipid-lowering drugs 80%).

Conclusion: Although cardiac drugs are under-prescribed to patients with AMI, once prescribed, patients are likely to adhere to these prescriptions, with high rates of compliance and persistence.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adrenergic beta-Antagonists / administration & dosage
  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Angiotensin-Converting Enzyme Inhibitors / administration & dosage
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use*
  • Aspirin / administration & dosage
  • Aspirin / therapeutic use*
  • Clinical Trials as Topic / statistics & numerical data
  • Databases as Topic
  • Drug Administration Schedule
  • Female
  • Guideline Adherence
  • Hospital Records
  • Humans
  • Hypolipidemic Agents / administration & dosage
  • Hypolipidemic Agents / therapeutic use*
  • Male
  • Myocardial Infarction / drug therapy*
  • Patient Compliance
  • Patient Discharge
  • Practice Patterns, Physicians'
  • Quebec


  • Adrenergic beta-Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Hypolipidemic Agents
  • Aspirin