Pharmacological treatment after acute myocardial infarction from 2001 to 2006: a survey in Italian primary care

J Cardiovasc Med (Hagerstown). 2009 Sep;10(9):714-8. doi: 10.2459/JCM.0b013e32832c6110.


Background: Pharmacological preventive therapy after acute myocardial infarction (AMI) is strictly recommended because of its great efficacy. Little is known about long-term utilization of drugs related to cardiovascular secondary prevention in everyday practice.

Design: A population-based cohort study on the basis of an Italian general practice database.

Methods: Searching a large primary-care Italian database (Health Search), we selected five cohorts of patients with first occurrence of AMI from 2001 to 2005, respectively, and analyzed prescriptions of antithrombotic agents, beta-blockers, statins and angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) from 2001 to 2006 (follow-up ranging from 1 to 5 years).

Results: We identified 4764 patients (mean age 67; 35% female) discharged from hospital after first-ever AMI. The prescription rate in the first year after AMI was suboptimal (beta-blockers 35.1%, aspirin or warfarin 75.0%, ACE-inhibitors or ARBs 61.6%, statins 52.8%) but showed a continuous improvement from 2001 to 2005. The prescription rate decreased slightly during the follow-up, but showed a complex pattern with a variable but significant number of patients discontinuing or resuming the therapy.

Conclusions: The prescription of recommended drugs after AMI has increased from 2001 to 2006 in Italy, but the prescription rate remains largely unsatisfactory. Therapeutic continuity is also suboptimal.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Aged
  • Aged, 80 and over
  • Angiotensin II Type 1 Receptor Blockers / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Cardiovascular Agents / therapeutic use*
  • Cohort Studies
  • Databases as Topic
  • Drug Prescriptions
  • Drug Utilization
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Guideline Adherence
  • Health Care Surveys
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Italy
  • Male
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians'* / statistics & numerical data
  • Primary Health Care* / statistics & numerical data
  • Time Factors
  • Treatment Outcome


  • Adrenergic beta-Antagonists
  • Angiotensin II Type 1 Receptor Blockers
  • Angiotensin-Converting Enzyme Inhibitors
  • Cardiovascular Agents
  • Fibrinolytic Agents
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors