Patterns of use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers among patients with acute myocardial infarction in China from 2001 to 2011: China PEACE-Retrospective AMI Study.
BACKGROUND
Chinese and U.S. guidelines recommend angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs) for all patients with acute myocardial infarction (AMI) in the absence of contraindications as either a Class I or Class IIa recommendation. Little is known about the use and trends of ACEI/ARB therapy in China over the past decade.


METHODS AND RESULTS
Using nationally representative data from the China Patient-centered Evaluative Assessment of Cardiac Events Retrospective Study of Acute Myocardial Infarction (China PEACE-Retrospective AMI Study), we assessed use of ACEI/ARB therapy in 2001, 2006, and 2011, overall and across geographic regions and strata of estimated mortality risk, and predictors of ACEI/ARB therapy, among patients with Class I indication by Chinese guidelines. The weighted rate of ACEI/ARB therapy increased from 62.0% in 2001 to 71.4% in 2006, decreasing to 67.6% in 2011. Use was low across all 5 geographic regions. By strata of estimated mortality risk, in 2001, rates of therapy increased with increasing risk; however, by 2011, this reversed and those at higher risk were less likely to be treated (70.7% in lowest-risk quintile vs. 63.5% in the highest-risk quintile; P<0.001).


CONCLUSION
One third of Chinese AMI patients with Class I indications do not receive ACEI/ARB therapy during hospitalization, with little improvement in rates over time. Patients at higher mortality risk in 2011 were less likely to be treated, highlighting important opportunities to optimize the use of this cost-effective therapy.


CLINICAL TRIAL REGISTRATION URL
ClinicalTrials.gov. Unique identifier: NCT01624883.
['Liu|Jiamin|J|', 'Masoudi|Frederick A|FA|', 'Spertus|John A|JA|', 'Wang|Qing|Q|', 'Murugiah|Karthik|K|', 'Spatz|Erica S|ES|', 'Li|Jing|J|', 'Li|Xi|X|', 'Ross|Joseph S|JS|', 'Krumholz|Harlan M|HM|', 'Jiang|Lixin|L|', '|||']
D000208:Acute Disease D047228:Angiotensin II Type 1 Receptor Blockers D000806:Angiotensin-Converting Enzyme Inhibitors D002681:China D005260:Female D006760:Hospitalization D006801:Humans D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D012189:Retrospective Studies D013997:Time Factors D016896:Treatment Outcome
acute myocardial infarction angiotensin‐converting enzyme inhibitors quality of care