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

Research output: Contribution to journalArticle

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 - Jan 1 2019

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Hospital Mortality
Prescriptions
Myocardial Infarction
Guidelines
Peptidyl-Dipeptidase A
Aspirin
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Mortality
Incidence
Vascular Diseases
Registries
Heart Diseases
Databases

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

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

In: Journal of the American Heart Association, Vol. 8, No. 7, e009692, 01.01.2019.

Research output: Contribution to journalArticle

Nakao, Kazuhiro ; Yasuda, Satoshi ; Nishimura, Kunihiro ; Noguchi, Teruo ; Nakai, Michikazu ; Miyamoto, Yoshihiro ; Sumita, Yoko ; Shishido, Toshiaki ; Anzai, Toshihisa ; Ito, Hiroshi ; Tsutsui, Hiroyuki ; Saito, Yoshihiko ; Komuro, Issei ; Ogawa, Hisao. / 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. In: Journal of the American Heart Association. 2019 ; Vol. 8, No. 7.
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title = "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",
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.",
author = "Kazuhiro Nakao and Satoshi Yasuda and Kunihiro Nishimura and Teruo Noguchi and Michikazu Nakai and Yoshihiro Miyamoto and Yoko Sumita and Toshiaki Shishido and Toshihisa Anzai and Hiroshi Ito and Hiroyuki Tsutsui and Yoshihiko Saito and Issei Komuro and Hisao Ogawa",
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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

PY - 2019/1/1

Y1 - 2019/1/1

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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