Prescription Rates of Guideline‐Directed Medications Are Associated With In‐Hospital Mortality Among Japanese Patients With Acute Myocardial Infarction: A Report From JROAD‐DPC Study

BACKGROUND: The JROAD‐DPC (Japanese Registry of All Cardiac and Vascular Diseases Diagnosis Procedure Combination) is a nationwide claims database comprised of the Japanese DPC/Per Diem Payment System. This study aimed to investigate the relationship between prescription rates of guideline‐directed medications in each hospital and in‐hospital mortality among patients with acute myocardial infarction. METHODS AND RESULTS: A total of 61 838 Japanese patients from 741 hospitals with acute myocardial infarction between 2012 and 2013 were enrolled. The relationship between prescription rates of 4 guideline‐directed medications for acute myocardial infarction and in‐hospital mortality was analyzed. There were variations in the prescription ratio of β‐blockers on admission (median prescription rate 23% [interquartile range 11% to 38%]) and at discharge (51% [36% to 63%]), and of angiotensin converting enzyme/receptor blocker (60% [47% to 70%]). The highest prescription rate quartile of each medication was associated with a significantly lower mortality compared with the lowest prescription rate quartile (aspirin on admission, incidence rate ratio 0.67 [95% CI 0.61‐0.74], P<0.001; aspirin at discharge, incidence rate ratio 0.50 [95% CI 0.46‐0.55], P<0.001; β‐blocker on admission, 0.83 [0.76‐0.92], P<0.001; β‐blocker at discharge, 0.78 [0.71‐0.85], P<0.001; angiotensin converting enzyme/receptor blocker, 0.68 [0.62‐0.75], P<0.001; statin, 0.63 [0.57‐0.70], P<0.001). The composite prescription score was inversely associated with in‐hospital mortality (β coefficient=−0.48, P<0.001) and was closer to the plateau in the high‐score range (median mortality for composite prescription scores of 6, 15, and 24 were 10.6%, 6.8%, and 4.6%, respectively). CONCLUSIONS: The prescription rates of guideline‐directed medications for treatment of Japanese acute myocardial infarction patients were inversely associated with in‐hospital mortality.