Guideline concordant prescribing following myocardial infarction in people who are frail: A systematic review.

Abstract

Aims

The risk-to-benefit ratio of cardioprotective medications in frail older adults is uncertain. The objective was to systematically review prescribing of guideline-recommended cardioprotective medications following myocardial infarction (MI) in people who are frail. Data sources

Ovid Medline, PubMed and Cochrane were searched from inception to October 2022 for studies that reported prescribing of one or more cardioprotective medication classes post-MI or acute coronary syndromes in people with frailty. Study selection

We included observational studies that reported prescribing of cardioprotective medications post-MI stratified by frailty status. Results

Overall, 16 cohort studies published from 2013 to 2022 that used seven different frailty scales were included. Prescribing of all cardioprotective medication classes following MI was lower in frail compared to non-frail people, with absolute rates of prescribing varying substantially across studies. Median prescribing in frail and non-frail people, respectively, was 88.9% (IQR 81.5–96.2) and 93.1% (IQR 92.0–98.9) for aspirin; 68.1% (IQR 61.9–91.2) and 86.7% (IQR 79.5–92.8) for P2Y12-inhibitors; 83.1% (IQR 76.9–91.3) and 94.0% (IQR 87.1–95.9) for lipid-lowering therapy; 67.9% (IQR 60.6–74.0) and 74.7% (IQR 71.3–84.5) for angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers; and 74.1% (IQR 69.2–79) and 77.6% (IQR 71.8–85.9) for beta-blockers. Conclusion

People who were frail were less likely to be prescribed guideline recommended medication classes post-MI than those who were non-frail. Further research is needed into treatment benefits and risks in frail people to avoid unnecessarily withholding treatment in this high-risk population, while also minimising potential for medication related harm.