TY - JOUR
T1 - Prescription rates of guideline-directed medications are associated with in-hospital mortality among Japanese patients with acute myocardial infarction
T2 - A report from JROAD-DPC study
AU - Nakao, Kazuhiro
AU - Yasuda, Satoshi
AU - Nishimura, Kunihiro
AU - Noguchi, Teruo
AU - Nakai, Michikazu
AU - Miyamoto, Yoshihiro
AU - Sumita, Yoko
AU - Shishido, Toshiaki
AU - Anzai, Toshihisa
AU - Ito, Hiroshi
AU - Tsutsui, Hiroyuki
AU - Saito, Yoshihiko
AU - Komuro, Issei
AU - Ogawa, Hisao
N1 - Funding Information:
Dr Yasuda reports grants and personal fees from Takeda, grants and personal fees from Daiichi-Sankyo, personal fees from Bristol-Myers, grants and personal fees from Bristol-Myers, and grants from Abbott unrelated to the submitted work. Dr Tsutsui reports grants from MSD, Daiichi-Sankyo, Tanabe-Mitsubishi, Teijin, Japan Tabaco, Nippon Boehringer, Actellion, and personal fees from MSD, Otsuka, Takeda, Tanabe-Mitsubishi, Daiichi-Sankyo, Nippon Boehringer, Novar-tis, Bayer, and Pfizer unrelated to the submitted work. Dr Saito has reported receiving personal fees from Mitsubishi Tanabe Pharma Corporation, Otsuka Pharmaceutical Co Ltd, Daiichi Sankyo Co Ltd, Novartis Pharma KK, Pfizer Japan Inc, and Nippon Boehringer Ingelheim Co Ltd. Dr Saito has received funding support from Mitsubishi Tanabe Pharma Corporation, Otsuka Pharmaceutical Co Ltd, Daiichi Sankyo Co Ltd, Novartis Pharma KK, Pfizer Japan Inc, Nippon Boehringer Ingelheim Co Ltd, Ono Pharmatical Co Ltd, St. Jude Medical Japan Co, Ltd, Bayer Holding Ltd, Terumo Corporation, Kyowa Hakko Kirin Co Ltd, Dainippon Sumitomo Pharma Co Ltd, Astellas Pharma Inc, Takeda Pharmaceutical Co Ltd, Teijin Pharma Ltd, Shionogi & Co Ltd, Kowa Pharmaceutical Co Ltd, and Actelion Pharmaceuticals Japan Ltd and also has a department endowed by MSD KK, all unrelated to the submitted work. Dr Komuro reports grants and personal fees from Takeda Pharmaceutical Company Limited, personal fees from Nippon Boehringer Ingelheim Co, Ltd, personal fees from MSD KK, grants from Astellas Pharma Inc, grants from Edwards Lifesciences Ltd, grants and personal fees from Mitsubishi Tanabe Pharma Corporation, personal fees from Actelion Pharmaceuticals Japan Ltd, grants and personal fees from Daiichi-Sankyo, personal fees from Amgen Astellas BioPharma KK, grants from Otsuka Pharmaceutical Co Ltd, Kowa company Ltd, grants from Dainippon Sumitomo Pharma Co Ltd, grants from Teijin Pharma Ltd, grants from Toa Eiyo Ltd, grants from Nipro Corporation, grants from Terumo Corporation, and grants from Ono Pharmaceutical Co Ltd, unrelated to the submitted work.
Funding Information:
The present work was supported in part by Health and Labor Sciences Research Grants from the Ministry of Health, Labor, and Welfare of Japan (H29-Junkanki-Ippan-001) (Yasuda), (H29-31-Junkanki-Ippan-005) (Yasuda), and a grant from Japan Agency for Medical Research and Development (16ek02 10018h 00 03) and was supported by the Japanese Circulation Society. This work was also supported by JSPS KAKENHI grant number 17K09548 (K. Nakao). The funders had no role in the design and conduct of the study; in the collection, management, analysis, or interpretation of the data; in the preparation, review, or approval of the manuscript; or in the decision to submit this article for publication.
Publisher Copyright:
© 2019 The Authors.
PY - 2019
Y1 - 2019
N2 - Background-The JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination) is a nationwide claims database comprised of the Japanese DPC/Per Diem Payment System. This study aimed to investigate the relationship between prescription rates of guideline-directed medications in each hospital and in-hospital mortality among patients with acute myocardial infarction. Methods and Results-A total of 61 838 Japanese patients from 741 hospitals with acute myocardial infarction between 2012 and 2013 were enrolled. The relationship between prescription rates of 4 guideline-directed medications for acute myocardial infarction and in-hospital mortality was analyzed. There were variations in the prescription ratio of β-blockers on admission (median prescription rate 23% [interquartile range 11% to 38%]) and at discharge (51% [36% to 63%]), and of angiotensin converting enzyme/receptor blocker (60% [47% to 70%]). The highest prescription rate quartile of each medication was associated with a significantly lower mortality compared with the lowest prescription rate quartile (aspirin on admission, incidence rate ratio 0.67 [95% CI 0.61-0.74], P<0.001; aspirin at discharge, incidence rate ratio 0.50 [95% CI 0.46-0.55], P<0.001; β-blocker on admission, 0.83 [0.76-0.92], P<0.001; β-blocker at discharge, 0.78 [0.71-0.85], P<0.001; angiotensin converting enzyme/receptor blocker, 0.68 [0.62-0.75], P<0.001; statin, 0.63 [0.57-0.70], P<0.001). The composite prescription score was inversely associated with inhospital mortality (β coefficient=-0.48, P<0.001) and was closer to the plateau in the high-score range (median mortality for composite prescription scores of 6, 15, and 24 were 10.6%, 6.8%, and 4.6%, respectively). Conclusions-The prescription rates of guideline-directed medications for treatment of Japanese acute myocardial infarction patients were inversely associated with in-hospital mortality.
AB - Background-The JROAD-DPC (Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination) is a nationwide claims database comprised of the Japanese DPC/Per Diem Payment System. This study aimed to investigate the relationship between prescription rates of guideline-directed medications in each hospital and in-hospital mortality among patients with acute myocardial infarction. Methods and Results-A total of 61 838 Japanese patients from 741 hospitals with acute myocardial infarction between 2012 and 2013 were enrolled. The relationship between prescription rates of 4 guideline-directed medications for acute myocardial infarction and in-hospital mortality was analyzed. There were variations in the prescription ratio of β-blockers on admission (median prescription rate 23% [interquartile range 11% to 38%]) and at discharge (51% [36% to 63%]), and of angiotensin converting enzyme/receptor blocker (60% [47% to 70%]). The highest prescription rate quartile of each medication was associated with a significantly lower mortality compared with the lowest prescription rate quartile (aspirin on admission, incidence rate ratio 0.67 [95% CI 0.61-0.74], P<0.001; aspirin at discharge, incidence rate ratio 0.50 [95% CI 0.46-0.55], P<0.001; β-blocker on admission, 0.83 [0.76-0.92], P<0.001; β-blocker at discharge, 0.78 [0.71-0.85], P<0.001; angiotensin converting enzyme/receptor blocker, 0.68 [0.62-0.75], P<0.001; statin, 0.63 [0.57-0.70], P<0.001). The composite prescription score was inversely associated with inhospital mortality (β coefficient=-0.48, P<0.001) and was closer to the plateau in the high-score range (median mortality for composite prescription scores of 6, 15, and 24 were 10.6%, 6.8%, and 4.6%, respectively). Conclusions-The prescription rates of guideline-directed medications for treatment of Japanese acute myocardial infarction patients were inversely associated with in-hospital mortality.
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U2 - 10.1161/JAHA.118.009692
DO - 10.1161/JAHA.118.009692
M3 - Article
C2 - 30909774
AN - SCOPUS:85063713033
SN - 2047-9980
VL - 8
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 7
M1 - e009692
ER -