The more evidence-based advice MI patients follow, the longer they survive

Heart patients who follow all guideline-recommended medical advice after an MI are far more likely than their peers to survive for years after a heart attack, researchers reported in the Journal of the American Heart Association this month.

The study, conducted by cardiologist and lead author Matthew D. Solomon, MD, PhD, and colleagues at Kaiser Permanente Northern California, assessed how many recommendations MI survivors were following 30 and 90 days after their heart attacks. Solomon et al. tracked seven recommendations, including adherence to beta-blockers; adherence to renin-angiotensin-aldosterone system inhibitors; adherence to lipid medications; adherence to antiplatelet medications; not smoking; achieving blood pressure control; and achieving cholesterol control. The team’s patient population included 25,000 people who had heart attacks between 2008 and 2014.

During 2.8 years of follow-up, Solomon et al. reported high compliance with individual components of Kaiser Permanente’s post-MI advice. Sixty-seven percent of patients reported taking prescribed non-aspirin antiplatelet drugs and 88% reported taking high cholesterol medications at 30 days, and results were similar at 90 days. One month into follow-up, it appeared that nearly 70% of patients achieved five or six guideline recommendations.

Results remained promising at 90 days—just over half of patients in the study were achieving six or seven of the recommendations the authors examined.

“People often think they are ‘fixed’ after they are treated for a heart attack,” Solomon said in a release. “But our findings show that following all the recommended treatments after a heart attack is critical to long-term health and wellness.”

Individuals in the study who followed all of Kaiser’s recommendations had “significantly” greater long-term survival, the authors said, seeing 39% to 43% lower mortality compared with people who followed the fewest recommendations. Adherence to one additional guideline recommendation was linked to an 8% to 11% lower risk of death.

“Our findings support the value of comprehensive secondary prevention efforts such as cardiac rehabilitation programs and patients’ own commitment to their recovery and a healthy lifestyle,” Solomon said, noting that it’s vital patients take follow-up care seriously.

“Doctors and patients must work to ensure every single evidence-based recommendation is followed. Following ‘most’ of the recommended treatments is not enough.”