Clinical characteristics of patients on cardiac rehabilitation program after acute myocardial infarction and evaluation of proper prescribing of cardiac medication at hospital discharge

Introduction: Myocardial infarction is a major cause of death and disability worldwide. American College of Cardiology (ACC) and American Heart Association (AHA) have presented several guidelines for the management of patients with acute myocardial infarction. Objective: The aim of this study was to: 1) Investigate the presence and the incidence of well-known, basic risk factors for coronary heart disease (CHD) in patients with STEMI and NSTEMI. 2) Evaluate medical therapy prescribed on hospital discharge, and 3) Determine the frequency of invasive strategy performed. Method: We performed an observational study on 84 patients who survived myocardial infarction (39% NSTEMI and 61% STEMI), 4-6 months before admission to the Institute for cardiovascular diseases and rehabilitation Niska Banja. They all attended cardiac rehabilitation program for 2-3 weeks. Based on the interview with the patients and prior medical records, we determined the incidence of risk factors for CHD: age, gender, hypertension, smoking, diabetes mellitus and hyperlipidemia. We investigated the intrahospital treatement of this patients and the incidence of invasive diagnostic procedure performed. The most important aim of this study was to evaluate the medical therapy prescribed upon hospital discharge. We wanted to know if it was optimal (acording to the latest guidelines). Optimal therapy includes: dual antiplatelet agents, β blockers, angiotensin converting enzyme inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins and nitroglycerin. Results: Patients with NSTEMI were significantly older, more often female and had higher incidence of hypertension, diabetes and raised blood trygliceride levels. Nitrates and calcium blockers were more frequently used in NSTEMI patients. Invasive diagnostic have been performed in almost the same percentage in our two groups (68,6%-STEMI, 69,7%-NSTEMI), same as PCI (percutaneus coronary intervention) and CABG (coronary artery bypass graft). All of our patients on discharge received aspirin. Among our patients, 61% (NSTEMI) and 63% (STEMI) were discharge on thyenopiridine, 84% (STEMI) and 91% (NSTEMI) on β blockers, 68% (STEMI) and 70% (NSTEMI) on ACEIs or ARBs, and 76% (NSTEMI) and 88% (STEMI) received a statin. 53,9% of our patients were discharged on optimal therapy, as recomended by ACC/AHA guidelines. Conclusion: Patients with NSTEMI in this survey were much older, more often female, and had higher incidence of co-morbidites. During Hospitalization, patients from both our groups were more often treated conservatively. Coronary angiography was more often done after discharge. The reason lies in the fact that a significant number of our patients were hospitalized in non-cardiology wards (mostly internal medicine ones), where the accessibility to recommended treatment is limited. Preskribed dose for cardiac medications upon hospital discharge were suboptimal.