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Antiarrhythmic Drug Prescription in Patients After Myocardial Infarction in the Last Decade: Experience of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico (GISSI)

Antiarrhythmic Drug Prescription in Patients After Myocardial Infarction in the Last Decade:... Abstract Background: Recent clinical trials have shown increased, rather than decreased, mortality in patients treated with antiarrhythmic drugs after acute myocardial infarction. Objective: To determine whether these findings had an impact on prescription of antiarrhythmic drugs after acute myocardial infarction. Methods: We retrospectively analyzed the class I and III antiarrhythmic prescription data of 38 072 patients with acute myocardial infarction enrolled in three large randomized clinical trials endorsed by a highly representative sample (about 75%) of Italian coronary care units during the last 10 years. The first study was conducted in 1984 to 1985; the second, in 1988 to 1989; the pilot for the third, in 1991; and the third, in 1991 to 1994. Results: Total class I and III antiarrhythmic prescriptions after acute myocardial infarction was halved during the last decade, from 11.9% at discharge and 14.4% at follow-up in 1984 to 1985 to 5.8% and 5.8%, respectively, in 1991 to 1994. The trend was independent of the different distributions in the three studies of the patients' characteristics associated with antiarrhythmic use (ie, age ≥70 years, anterior acute myocardial infarction, ventricular fibrillation during hospitalization, and Killip class ≥2 at randomization). The same decreasing trend was observed for each antiarrhythmic drug. The drug most widely used was amiodarone, accounting for about half of the antiarrhythmic prescriptions, followed by mexiletine hydrochloride and propafenone hydrochloride; flecainide acetate was dropped from the prescription list after the publication of the Cardiac Arrhythmia Suppression Trial results. Conclusion: The negative results of the recent clinical trials on class I antiarrhythmic drug use after acute myocardial infarction have been rapidly transferred into routine clinical practice in Italy, since the proportion of patients who received class I and III antiarrhythmic drugs after acute myocardial infarction was halved from the early 1980s to the early 1990s.(Arch Intern Med. 1995;155:1041-1045) References 1. The Coronary Drug Project Research Group. Prognostic importance of premature beats following myocardial infarction: experience in the coronary drug project. JAMA . 1973;223:1116-1124.Crossref 2. Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Chaudhary BS, Shapiro S. Ventricular premature complexes and sudden death after myocardial infarction. Circulation . 1981;64:297-305.Crossref 3. Bigger JT, Weld FM, Rolnitzky LM. Prevalence, characteristics and significance of ventricular tachycardia (three or more complexes) detected with ambulatory electrocardiographic recording in the late hospital phase of acute myocardial infarction. Am J Cardiol . 1981;48:815-823.Crossref 4. The Multicenter Postinfarction Research Group. Risk stratification and survival after myocardial infarction. N Engl J Med . 1983;309:331-336.Crossref 5. Bigger JT, Fleiss JL, Kleiger R, Miller JP, Rolnitzky LM, Multicenter Postinfarction Research Group. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation . 1984;69:250-258.Crossref 6. Mukharji J, Rude RE, Poole WK, et al. Risk factors for sudden death after myocardial infarction: two-year follow-up. Am J Cardiol . 1984;54:31-36.Crossref 7. Kostis JB, Byington R, Friedman LM, Goldstein S, Furberg C, BHAT Study Group. Prognostic significance of ventricular ectopic activity in survivors of acute myocardial infarction. J Am Coll Cardiol . 1987;10:231-242. 8. Maggioni AP, Zuanetti G, Franzosi MG, et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era: GISSI-2 results. Circulation . 1993;87:312-322.Crossref 9. Hine LK, Laird NM, Hewitt P, Chalmers TC. Meta-analysis of empirical longterm antiarrhythmic therapy after myocardial infarction. JAMA . 1989;262:3037-3040.Crossref 10. Teo KK, Yusuf S, Furberg CD. Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction: an overview of results from randomized controlled trials. JAMA . 1993;270:1589-1595.Crossref 11. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med . 1989;312: 406-412.Crossref 12. Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the Cardiac Arrhythmia Suppression Trial. N Engl J Med . 1991;324:781-788.Crossref 13. The Cardiac Arrhythmia Suppression Trial II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med . 1992;327:227-233.Crossref 14. Pratt CM, Brater DC, Harrell FE, et al. Clinical and regulatory implication of the Cardiac Arrhythmia Suppression Trial. Am J Cardiol . 1990;65:103-105.Crossref 15. Morganroth J, Bigger JT. Pharmacologic management of ventricular arrhythmias after the Cardiac Arrhythmia Suppression Trial. Am J Cardiol . 1990:65: 1497-1503.Crossref 16. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet . 1986;1:397-402. 17. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. GISSI-2: a factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet . 1990;336:65-71. 18. GISSI-3 Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. GISSI-3 study protocol on the effects of lisinopril, of nitrates, and of their association in patients with acute myocardial infarction. Am J Cardiol . 1992;70:62C-69C. 19. SAS Institute Inc. SUGI Supplemental Library Users's Guide . Cary, NC: SAS Institute Inc; 1986:269-293. 20. Vlay SC, Brook S. How the university cardiologist treats ventricular premature beats: a nationwide survey of 65 university medical centers. Am Heart J . 1985; 110:904-910.Crossref 21. Hlatky MA, Cotugno HE, Mark DB, O'Connor C, Califf RM, Pryor DB. Trends in physician management of uncomplicated acute myocardia infarction, 1970 to 1987. Am J Cardiol . 1988;61:515-518.Crossref 22. Boissel JP, Nèmoz C, Gillet J, Salewski B, Diaz N, Groupe de pharmacologie et de thérapeutique de la Société francaise de cardiologie. La prescription médicamenteuse dans le postinfarctus: résultats de l'EPPI (étude de prescription postinfarctus). Arch Mal Coeur . 1990;83:1777-1782. 23. Morganroth J, Bigger JT, Anderson JL. Treatment of ventricular arrhythmias by United States cardiologists: a survey before the Cardiac Arrhythmia Suppression Trial results were available. Am J Cardiol . 1990;65:40-48.Crossref 24. Reiftel JA, Cook JR. Physician attitudes toward the use of type IC antiarrhythmics after the Cardiac Arrhythmia Suppression Trial (CAST). Am J Cardiol . 1990;66:1262-1264.Crossref 25. Latini R, Avanzini F, Zuanetti G, et al. Changing patterns of pharmacological treatment after myocardial infarction: the GISSI experience. J Am Coll Cardiol . 1994;23( (suppl) ):210A. 26. Zuanetti G, Latini R, Avanzini F, et al. Prescription of calcium antagonists after myocardial infarction: the GISSI Experience. J Am Coll Cardiol . 1994; 23( (suppl) ):210A. 27. Tognoni G, Franzosi MG, Garattini S, et al. The case of GISSI in changing the attitudes and practice of Italian cardiologists. Stat Med . 1990;9:17-27.Crossref 28. Burkart F, Pfisterer M, Kiowski W, Follath F, Burckhardt D, Jordi H. Effects of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS). J Am Coll Cardiol . 1990;16:1711-1718. 29. Ceremuzynski L, Kleczar E, Krzeminska-Pakula M, et al. Effect of amiodarone on mortality after myocardial infarction: a double-blind, placebo-controlled, pilot study. JAm Coll Cardiol . 1992;20:1056-1062.Crossref 30. Chalmers TC. The impact of controlled trials on practice of medicine. Mt Sinai J Med . 1974;41:753-759. 31. Stross JK, Harlan WR. The dissemination of new medical information. JAMA . 1979:241:2622-2624.Crossref 32. Avorn J, Chen M, Hartley R. Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med . 1982;73:4-8.Crossref 33. Gamier HS, Flamant R, Fohanno C. Assessment of the role of randomized clinical trials in establishing treatment policies. Controlled Clin Trials . 1982;3:227-234.Crossref 34. Lamas GA, Pfeffer MA, Hamm P. Wertheimer J, Rouleau JL, Braunwald E. Do the results of randomized clinical trials of cardiovascular drugs influence medical practice? N Engl J Med . 1992;327:241-247.Crossref 35. Ketley D. Woods KL. Impact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction. Lancet . 1993;342:891-894.Crossref 36. Clinical trials and clinical practice. Lancet . 1993:342:877-878.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Antiarrhythmic Drug Prescription in Patients After Myocardial Infarction in the Last Decade: Experience of the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico (GISSI)

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430100065007
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Abstract

Abstract Background: Recent clinical trials have shown increased, rather than decreased, mortality in patients treated with antiarrhythmic drugs after acute myocardial infarction. Objective: To determine whether these findings had an impact on prescription of antiarrhythmic drugs after acute myocardial infarction. Methods: We retrospectively analyzed the class I and III antiarrhythmic prescription data of 38 072 patients with acute myocardial infarction enrolled in three large randomized clinical trials endorsed by a highly representative sample (about 75%) of Italian coronary care units during the last 10 years. The first study was conducted in 1984 to 1985; the second, in 1988 to 1989; the pilot for the third, in 1991; and the third, in 1991 to 1994. Results: Total class I and III antiarrhythmic prescriptions after acute myocardial infarction was halved during the last decade, from 11.9% at discharge and 14.4% at follow-up in 1984 to 1985 to 5.8% and 5.8%, respectively, in 1991 to 1994. The trend was independent of the different distributions in the three studies of the patients' characteristics associated with antiarrhythmic use (ie, age ≥70 years, anterior acute myocardial infarction, ventricular fibrillation during hospitalization, and Killip class ≥2 at randomization). The same decreasing trend was observed for each antiarrhythmic drug. The drug most widely used was amiodarone, accounting for about half of the antiarrhythmic prescriptions, followed by mexiletine hydrochloride and propafenone hydrochloride; flecainide acetate was dropped from the prescription list after the publication of the Cardiac Arrhythmia Suppression Trial results. Conclusion: The negative results of the recent clinical trials on class I antiarrhythmic drug use after acute myocardial infarction have been rapidly transferred into routine clinical practice in Italy, since the proportion of patients who received class I and III antiarrhythmic drugs after acute myocardial infarction was halved from the early 1980s to the early 1990s.(Arch Intern Med. 1995;155:1041-1045) References 1. The Coronary Drug Project Research Group. Prognostic importance of premature beats following myocardial infarction: experience in the coronary drug project. JAMA . 1973;223:1116-1124.Crossref 2. Ruberman W, Weinblatt E, Goldberg JD, Frank CW, Chaudhary BS, Shapiro S. Ventricular premature complexes and sudden death after myocardial infarction. Circulation . 1981;64:297-305.Crossref 3. Bigger JT, Weld FM, Rolnitzky LM. Prevalence, characteristics and significance of ventricular tachycardia (three or more complexes) detected with ambulatory electrocardiographic recording in the late hospital phase of acute myocardial infarction. Am J Cardiol . 1981;48:815-823.Crossref 4. The Multicenter Postinfarction Research Group. Risk stratification and survival after myocardial infarction. N Engl J Med . 1983;309:331-336.Crossref 5. Bigger JT, Fleiss JL, Kleiger R, Miller JP, Rolnitzky LM, Multicenter Postinfarction Research Group. The relationships among ventricular arrhythmias, left ventricular dysfunction, and mortality in the 2 years after myocardial infarction. Circulation . 1984;69:250-258.Crossref 6. Mukharji J, Rude RE, Poole WK, et al. Risk factors for sudden death after myocardial infarction: two-year follow-up. Am J Cardiol . 1984;54:31-36.Crossref 7. Kostis JB, Byington R, Friedman LM, Goldstein S, Furberg C, BHAT Study Group. Prognostic significance of ventricular ectopic activity in survivors of acute myocardial infarction. J Am Coll Cardiol . 1987;10:231-242. 8. Maggioni AP, Zuanetti G, Franzosi MG, et al. Prevalence and prognostic significance of ventricular arrhythmias after acute myocardial infarction in the fibrinolytic era: GISSI-2 results. Circulation . 1993;87:312-322.Crossref 9. Hine LK, Laird NM, Hewitt P, Chalmers TC. Meta-analysis of empirical longterm antiarrhythmic therapy after myocardial infarction. JAMA . 1989;262:3037-3040.Crossref 10. Teo KK, Yusuf S, Furberg CD. Effects of prophylactic antiarrhythmic drug therapy in acute myocardial infarction: an overview of results from randomized controlled trials. JAMA . 1993;270:1589-1595.Crossref 11. The Cardiac Arrhythmia Suppression Trial (CAST) Investigators. Preliminary report: effect of encainide and flecainide on mortality in a randomized trial of arrhythmia suppression after myocardial infarction. N Engl J Med . 1989;312: 406-412.Crossref 12. Echt DS, Liebson PR, Mitchell LB, et al. Mortality and morbidity in patients receiving encainide, flecainide, or placebo: the Cardiac Arrhythmia Suppression Trial. N Engl J Med . 1991;324:781-788.Crossref 13. The Cardiac Arrhythmia Suppression Trial II Investigators. Effect of the antiarrhythmic agent moricizine on survival after myocardial infarction. N Engl J Med . 1992;327:227-233.Crossref 14. Pratt CM, Brater DC, Harrell FE, et al. Clinical and regulatory implication of the Cardiac Arrhythmia Suppression Trial. Am J Cardiol . 1990;65:103-105.Crossref 15. Morganroth J, Bigger JT. Pharmacologic management of ventricular arrhythmias after the Cardiac Arrhythmia Suppression Trial. Am J Cardiol . 1990:65: 1497-1503.Crossref 16. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet . 1986;1:397-402. 17. Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. GISSI-2: a factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet . 1990;336:65-71. 18. GISSI-3 Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico. GISSI-3 study protocol on the effects of lisinopril, of nitrates, and of their association in patients with acute myocardial infarction. Am J Cardiol . 1992;70:62C-69C. 19. SAS Institute Inc. SUGI Supplemental Library Users's Guide . Cary, NC: SAS Institute Inc; 1986:269-293. 20. Vlay SC, Brook S. How the university cardiologist treats ventricular premature beats: a nationwide survey of 65 university medical centers. Am Heart J . 1985; 110:904-910.Crossref 21. Hlatky MA, Cotugno HE, Mark DB, O'Connor C, Califf RM, Pryor DB. Trends in physician management of uncomplicated acute myocardia infarction, 1970 to 1987. Am J Cardiol . 1988;61:515-518.Crossref 22. Boissel JP, Nèmoz C, Gillet J, Salewski B, Diaz N, Groupe de pharmacologie et de thérapeutique de la Société francaise de cardiologie. La prescription médicamenteuse dans le postinfarctus: résultats de l'EPPI (étude de prescription postinfarctus). Arch Mal Coeur . 1990;83:1777-1782. 23. Morganroth J, Bigger JT, Anderson JL. Treatment of ventricular arrhythmias by United States cardiologists: a survey before the Cardiac Arrhythmia Suppression Trial results were available. Am J Cardiol . 1990;65:40-48.Crossref 24. Reiftel JA, Cook JR. Physician attitudes toward the use of type IC antiarrhythmics after the Cardiac Arrhythmia Suppression Trial (CAST). Am J Cardiol . 1990;66:1262-1264.Crossref 25. Latini R, Avanzini F, Zuanetti G, et al. Changing patterns of pharmacological treatment after myocardial infarction: the GISSI experience. J Am Coll Cardiol . 1994;23( (suppl) ):210A. 26. Zuanetti G, Latini R, Avanzini F, et al. Prescription of calcium antagonists after myocardial infarction: the GISSI Experience. J Am Coll Cardiol . 1994; 23( (suppl) ):210A. 27. Tognoni G, Franzosi MG, Garattini S, et al. The case of GISSI in changing the attitudes and practice of Italian cardiologists. Stat Med . 1990;9:17-27.Crossref 28. Burkart F, Pfisterer M, Kiowski W, Follath F, Burckhardt D, Jordi H. Effects of antiarrhythmic therapy on mortality in survivors of myocardial infarction with asymptomatic complex ventricular arrhythmias: Basel Antiarrhythmic Study of Infarct Survival (BASIS). J Am Coll Cardiol . 1990;16:1711-1718. 29. Ceremuzynski L, Kleczar E, Krzeminska-Pakula M, et al. Effect of amiodarone on mortality after myocardial infarction: a double-blind, placebo-controlled, pilot study. JAm Coll Cardiol . 1992;20:1056-1062.Crossref 30. Chalmers TC. The impact of controlled trials on practice of medicine. Mt Sinai J Med . 1974;41:753-759. 31. Stross JK, Harlan WR. The dissemination of new medical information. JAMA . 1979:241:2622-2624.Crossref 32. Avorn J, Chen M, Hartley R. Scientific versus commercial sources of influence on the prescribing behavior of physicians. Am J Med . 1982;73:4-8.Crossref 33. Gamier HS, Flamant R, Fohanno C. Assessment of the role of randomized clinical trials in establishing treatment policies. Controlled Clin Trials . 1982;3:227-234.Crossref 34. Lamas GA, Pfeffer MA, Hamm P. Wertheimer J, Rouleau JL, Braunwald E. Do the results of randomized clinical trials of cardiovascular drugs influence medical practice? N Engl J Med . 1992;327:241-247.Crossref 35. Ketley D. Woods KL. Impact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction. Lancet . 1993;342:891-894.Crossref 36. Clinical trials and clinical practice. Lancet . 1993:342:877-878.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 22, 1995

References