Prescription rates of guideline-directed medications are associated with in-hospital mortality among Japanese patients with acute myocardial infarction: A report from JROAD-DPC study

Kazuhiro Nakao, Satoshi Yasuda, Kunihiro Nishimura, Teruo Noguchi, Michikazu Nakai, Yoshihiro Miyamoto, Yoko Sumita, Toshiaki Shishido, Toshihisa Anzai, Hiroshi Ito, Hiroyuki Tsutsui, Yoshihiko Saito, Issei Komuro, Hisao Ogawa

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Abstract

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.

Original languageEnglish
Article numbere009692
JournalJournal of the American Heart Association
Volume8
Issue number7
DOIs
Publication statusPublished - 2019

Keywords

  • Acute myocardial infarction
  • Medication
  • Quality indicators

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Nakao, K., Yasuda, S., Nishimura, K., Noguchi, T., Nakai, M., Miyamoto, Y., Sumita, Y., Shishido, T., Anzai, T., Ito, H., Tsutsui, H., Saito, Y., Komuro, I., & Ogawa, H. (2019). Prescription rates of guideline-directed medications are associated with in-hospital mortality among Japanese patients with acute myocardial infarction: A report from JROAD-DPC study. Journal of the American Heart Association, 8(7), [e009692]. https://doi.org/10.1161/JAHA.118.009692