Patient knowledge about risk factors, achievement of target values, and guideline-adherent secondary prevention therapies 12 months after acute myocardial infarction
Authors: Zeymer Uwe , Goss Franz , Kunadt Marcel , Oldenburg Susanne , Hochadel Mathias , Thiele Holger , Werdan Karl ,   GULLIVE-R Investigators, Wilke Andreas , Schirmer Stephan , Seiffert Ulrich , Axthelm Christoph , Kindler Patrizia , Brinkhoff Jens , Unger Bariele , Taggeselle Jens , Trautwein Dorothea , Langel Jörg , Häntze Sandrina , Wolf Uulrich , Thelemann Andreas , Towae Frank , Grooterhorst Peter , Haßler Normann , Baar Makus , Schlichting Jürgen , Haas Johannes , Birkenhagen Annette , Haney matthias , Ladendorf Karoline , Ernstberger Jan , Wendtland Jörg , Overhoff Ulrich , Hauser Ernst-Richard , Haerer Winfried , Brinkmann René , Henschel Frank , Simon-Wagner Ilka , Jeserich Michael , Süselbeck Tim , Gabelmann Matthias , Riesner Helmut , Schomburg Rolf , Krämer Fabian , Reibis Rona , Menz Volker , Layher Trudbert , Krapivsky Alexander , Sinn Lutz , Placke Jens , Spengler Ulrike , Schmitz Karl-Heinz , Richter Wlater , Klutmann Martin , Rink Anke , Paitazoglou Christina , löber Felix , Abegunewardene Nico , Altmann Ute , Törnberg Philip , Gysan Deltef Bernd , Goller Veit , Bosch Ralph , Moll Detlev , Kaspar Thomas , Guth Angelika , Kimmel Simone , Schickentanz Andrés Balmaceda , borgmann Harald , Haj-Yehia Afif , Jäger Frank , Frickel Siegfried , Janßen Hendrik , Staberock Manfred , Raupach Arno , Kuhl Thomas , Kintrup Tobias , Varga Katarina , Bott Jochen , Hellemann Dirk , Derau-van der Werff Claudia , Tews Dietrich , Klein Alexander , Schmidt Thomas , Lehinant Stefan , Fritz Stephan , Eisold Alexander , Strohm Oliver , Scheibner Thomas , Heinz Gerd-Ulrich , Klein Bärbel , Wilhelm Karl , Seeger Wolfgang , Müller Bernd-Torsten , Mayerhoff Henning , Jonas Nils , Walter Thomas , Hermann Matthias , Jäck Ulrich , Flämig Jakob , Göring Norbert , Bustami Hatem , Ditzler Alexander , Bindig Hans-Walter , Könemann Kai , Maaß Wilhem , Goss Franz , Rybak Karin , Schmidt Michaela , Vormann Reinhold , Zhang Hao , Eissing Volker , Ragab Samir , Osman Neriman , Wolfram Oliver , Ebert Frank , Zimny Hans-Hermann , Weberling Focko , Franjic Ivka , Knöbel Karsten , Greve Andreas , Viergutz Christoph , Pitule Hannelore , Lorenz Henrik , Abdul-Malak Patrick , Zugck Christian , Adjan Omar , Rüdell Ulrich , Schwarzbach Frank 
Published: May 2024

Abstract

Aims
The prospective GULLIVE-R study aimed to evaluate adherence to guideline-recommended secondary prevention, physicians’ and patients’ estimation of cardiac risk, and patients’ knowledge about target values of risk factors after acute myocardial infarction (AMI).

Methods and results
We performed a prospective study enrolling patients 9–12 months after AMI. Guideline-recommended secondary prevention therapies and physicians as well as patients’ estimation about their risk and patients’ knowledge about target values were prospectively collected. Between July 2019 and June 2021, a total of 2509 outpatients were enrolled in 150 German centres 10 months after AMI. The mean age was 66 years, 26.4% were women, 45.3% had ST elevation myocardial infarction, 54.7% had non-ST elevation myocardial infarction, and 93.6% had revascularization (84.0% percutaneous coronary intervention, 7.4% coronary artery bypass graft, 1.8% both). Guideline-recommended secondary drug therapies were prescribed in over 80% of patients, while only about 50% received all five recommended drugs (aspirin, P2Y12 inhibitors, statins, beta-blockers, renin–angiotensin–aldosterone system inhibitors), and regular exercise was performed by only one-third. About 90% of patients felt well informed about secondary prevention, but the correct target value for blood pressure was known in only 37.9% and for LDL-cholesterol in only 8.2%. Both physicians and patients underestimated the objective risk of future AMIs as determined by the thormbolysis in myocardial infarction (TIMI) risk score for secondary prevention.

Conclusion
There is still room for improvement in patient education and implementation of guideline-recommended non-pharmacological and pharmacological secondary prevention therapies in patients in the chronic phase after AMI.