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Time Trends and Gender Differences in Prevention Guideline Adherence and Outcome after Myocardial Infarction: Data from the SWEDEHEART-registry
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology.ORCID iD: 0000-0002-0768-2484
Skane University Hospital Lund.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Cardiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, UCR-Uppsala Clinical Research Center.
2016 (English)In: European Journal of Preventive Cardiology, ISSN 2047-4873, E-ISSN 2047-4881, Vol. 23, no 4, 340-348 p.Article in journal (Refereed) Published
Abstract [en]

Background While secondary prevention improves prognosis after acute myocardial infarction (AMI), previous studies have suggested suboptimal guideline adherence, lack of improvement over time and gender differences. This study contributes contemporary data from a large national cohort. Method We identified 51,620 patients <75 years examined at two and/or twelve months post AMI in the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies (SWEDEHEART). Risk factor control and readmissions at one year were compared between the 2005 and 2012 cohorts, and between genders. Results Lipid control (LDL-cholesterol <2.5mmol/L) improved from 67.9% to 71.1% (p=0.016) over time, achieved by 67.9% vs 63.3%, p<0.001 of men vs women. Blood pressure control (<140mmHg systolic) increased over time (59.1% vs 69.5%, p<0.001 in 2005 and 2012 cohorts) and was better in men (66.4% vs 61.9%, p<0.001). Smoking cessation rate was 55.6% without differences between genders or over time. Cardiac readmissions occurred in 18.2% of women and 15.5% of men, decreasing from 2005 to 2012 (20.8% vs 14.9%). Adjusted odds ratio was 1.22 (95% CI 1.14-1.32) for women vs men and 0.94 (95% CI 0.92-0.96) for the 2012 vs the 2005 cohort. Conclusions Although this study compares favourably to previous studies of risk factor control post AMI, improvement over time was mainly seen regarding blood pressure, revealing substantial remaining preventive potential. The reasons for gender differences seen in risk factor control and readmissions require further analysis.

Place, publisher, year, edition, pages
2016. Vol. 23, no 4, 340-348 p.
National Category
Cardiac and Cardiovascular Systems
URN: urn:nbn:se:uu:diva-233160DOI: 10.1177/2047487315585293ISI: 000370071300001PubMedID: 25986497OAI: oai:DiVA.org:uu-233160DiVA: diva2:750732
Swedish Association of Local Authorities and Regions
Available from: 2014-09-29 Created: 2014-09-29 Last updated: 2016-03-23Bibliographically approved
In thesis
1. From Stenting to Preventing: Invasive and Long-term Treatment for Coronary Artery Disease in Sweden
Open this publication in new window or tab >>From Stenting to Preventing: Invasive and Long-term Treatment for Coronary Artery Disease in Sweden
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Coronary artery disease (CAD) is the leading cause of death worldwide. Treatment with coronary interventions, long-term treatment and life style changes can reduce symptoms and improve prognosis. The aim of this thesis was to investigate aspects of invasive treatment for multivessel coronary artery disease, and to investigate adherence to prevention guidelines one year after myocardial infarction.

 We used the national quality registry SWEDEHEART to collect data on long term treatment one year after myocardial infarction for 51 620 patients < 75 years of age. For 17 236 of the patients, we collected LDL-cholesterol measurements from SWEDEHEART and defined use of lipid lowering drugs from the Prescribed Drug Register. We developed a questionnaire for post-PCI-patients to investigate patients’ understanding of cause and treatment of coronary artery disease. For 23 342 PCI-patients with multivessel coronary artery disease, SWEDEHEART-data was linked to Swedish health data registries to determine one year outcome for patients undergoing incomplete vs. complete revascularization.

  Lipid control (LDL-cholesterol < 1.8 mmol/L) was attained by one in four patients one year after myocardial infarction, whereas blood pressure control (< 140 mmHg) was attained by two thirds of patients. Lipid and blood pressure control was lower for women but there was no gender difference in smoking cessation rate: 56 %. Over 90 % of patients were treated with a statin after myocardial infarction but treatment was intensified for only one in five patients with LDL-cholesterol above target.

The questionnaire study revealed that non-modifiable factors such as age and heredity were more often seen as cause of coronary artery disease than modifiable life style factors. Only one in five patients perceived CAD as a chronic illness, requiring life style changes.

Two thirds of PCI-patients with multivessel disease underwent incomplete revascularisation, and this was associated with a twofold risk for the combination of death, myocardial infarction and repeat revascularization up to one year, compared to patients who underwent complete revascularization.

We conclude that  long term treatment after myocardial infarction is suboptimal in relation to guideline recommendations. Assessment of patients’ views on CAD and better health education post PCI may facilitate life style changes. Further studies need to investigate whether complete revascularization will improve outcome for PCI-patients with multivessel disease.


Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 76 p.
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1033
Coronary artery disease, guideline adherence, prevention, cholesterol treatment, lifestyle, percutaneous coronary intervention
National Category
Cardiac and Cardiovascular Systems
Research subject
urn:nbn:se:uu:diva-233167 (URN)978-91-554-9051-5 (ISBN)
Public defence
2014-11-13, Museum Gustavianum, Akademigatan 3, Uppsala, 13:00 (English)
Available from: 2014-10-23 Created: 2014-09-29 Last updated: 2015-01-23

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