• Caterina Mas-Llado, Xavier Rossello, Maribel González-Del-Hoyo, Stuart Pocock, de WerfFrans VanFVDepartment of Cardiovascular Sciences, University of Leuven, Belgium., Chee Tang Chin, Nicolas Danchin, Stephen W-L Lee, Jesús Medina, Yong Huo, and Héctor Bueno.
• Cardiology Department, Hospital de Manacor, Spain; Health Research Institute of the Balearic Islands, Palma, Spain; Facultad de Medicina, Universitat de les Illes Balears, Palma, Spain.
• Am. J. Med. 2024 Feb 1; 137 (2): 137146.e10137-146.e10.

ObjectiveWe aimed to evaluate the applicability of the eligibility criteria of randomized controlled trials (RCTs) cited in guideline recommendations in a real-world cohort of patients receiving secondary prevention after acute myocardial infarction from the EPICOR registries.MethodsRecommendations provided by American and European guidelines for acute myocardial infarction were classified into general (applying to all patients) and specific (applying to patients with left ventricular dysfunction or heart failure). Randomized controlled trials cited in these recommendations were selected, and their entry criteria were applied to our international cohort of 18,117 patients.ResultsThere were 91.5% patients eligible for beta blockers (84.6% for general, and 5.9% for specific recommendations), 97.7% eligible for renin-angiotensin system inhibitor (angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers [ACEI/ARB]) recommendations (69.9% for general, 27.9% for specific) and 4.1% eligible for mineralocorticoid receptor antagonists (only specific recommendations). The percentages of patients with eligibility criteria who were discharged with a prescription of the recommended therapies were 80%-85% for beta blockers, 70%-75% for ACEI/ARB, and 29% for mineralocorticoid receptor antagonists. There were large regional variations in the percentage of eligible patients and in those receiving the medications (eg, 95% in Northern Europe and 57% in Southeast Asia for beta blockers).ConclusionMost real-world acute myocardial infarction patients are eligible for secondary prevention therapy in both general and specific guideline recommendations, and the percentage of those on beta blockers and ACEI/ARB at hospital discharge is high. There are large regional variations in the proportion of patients receiving recommended therapies. Local targeted interventions are needed for quality improvement.Copyright © 2023. Published by Elsevier Inc.

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