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Combination evidence-based therapy is effective in the oldest ‘old patients’ following myocardial infarction. The “Salute e Benessere nell’Anziano” (SeBA) observational study

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Abstract

Antiplatelet drugs, statins, angiotensinogen-converting enzyme inhibitors or angiotensin-II receptor blockers, and β-blockers improve survival following myocardial infarction (MI). However, in old age they are under-prescribed, and their effectiveness in combination regimens is unproven. The aim of the study was to evaluate prescription of recommended cardiovascular drug classes and impact of a combination regimen on long-term mortality and hospitalizations. Records of 65+ years MI survivors, discharged from hospitals in four Local Health Units in Italy, were selected from administrative databases and analyzed. All-cause mortality and cardiovascular re-hospitalization in 12 months were compared across participants prescribed 0, 1, 2, 3, or 4 recommended drug classes. Out of 2626 participants (56 % men, 25 % aged 85+ years), 42 % were prescribed all, 14 % none of the recommended drug classes. The prescription rate decreased with advancing age. At all ages, mortality decreased with increasing number of drug classes prescribed: in participants aged 85+ years, adjusted hazard ratios (95 % confidence interval) for death were 0.74 (0.47–1.17), 0.52 (0.33–0.82), 0.30 (1.19–0.48), and 0.33 (0.20–0.53) for 1, 2, 3, and 4 classes prescribed, compared with none. The risk of cardiovascular re-hospitalizations decreased with an increasing number of drug classes prescribed through the age of 84 years. After MI, a combination regimen of recommended drug classes prevents long-term mortality at any age, and cardiovascular re-hospitalizations through the age of 84. Enhancing compliance with treatment guidelines may reduce the burden of mortality and hospitalizations in older MI survivors.

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Acknoweldgements

Funding

This study is supported by an unrestricted grant by the non-profit Sanofi Aventis Foundation (Milan, Italy). The sponsor played no role in the design of the study, analysis or interpretation of findings, nor in the preparation of the manuscript.

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Authors and Affiliations

  1. Research Unit of Medicine of Aging, Department of Experimental and Clinical Medicine, University of Florence, Viale Pieraccini, 18, 50139, Florence, Italy

    Mauro Di Bari, Samuele Baldasseroni, Enrico Mossello, Stefano Fumagalli & Niccolò Marchionni

  2. Division of Geriatric Cardiology and Medicine, Department of Geriatrics and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Mauro Di Bari, Samuele Baldasseroni, Enrico Mossello, Stefano Fumagalli & Niccolò Marchionni

  3. CliCon srl Health, Economics and Outcomes Research, Ravenna, Italy

    Luca Degli Esposti & Chiara Veronesi

  4. Italian Medicines Agency, Rome, Italy

    Sergio Pecorelli

  5. IRCCS San Raffaele, Rome, Italy

    Massimo Fini

  6. Sanofi Aventis Foundation, Milan, Italy

    Marco Scatigna

Authors
  1. Mauro Di Bari
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  2. Luca Degli Esposti
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  3. Chiara Veronesi
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  4. Sergio Pecorelli
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  5. Massimo Fini
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  7. Enrico Mossello
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  8. Stefano Fumagalli
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  9. Marco Scatigna
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  10. Niccolò Marchionni
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Corresponding author

Correspondence to Mauro Di Bari.

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Conflict of interest

MS is General Director of the non-profit Sanofi Aventis Foundation (Milan, Italy). All the other authors have no competing interests that relate to this manuscript.

Statement of human and animal rights

The study was approved by local ethics committees

Informed consent

According to Italian laws, informed consent was not required, as the study was based upon administrative, anonymized data.

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Di Bari, M., Esposti, L.D., Veronesi, C. et al. Combination evidence-based therapy is effective in the oldest ‘old patients’ following myocardial infarction. The “Salute e Benessere nell’Anziano” (SeBA) observational study. Intern Emerg Med 11, 677–685 (2016). https://doi.org/10.1007/s11739-016-1391-0

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  • DOI: https://doi.org/10.1007/s11739-016-1391-0

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