ORIGINAL RESEARCH ARTICLE Secondary Prevention Medication After Myocardial Infarction: Persistence in Elderly People over the Course of 1 Year Saba Al-Khadra • Christa Meisinger • Ute Amann • Rolf Holle • Bernhard Kuch • Hildegard Seidl • Inge Kirchberger Published online: 12 June 2014 Ó Springer International Publishing Switzerland 2014 Abstract Aims Persistent use of guideline-recommended drugs after acute myocardial infarction (AMI) is frequently reported to be inadequate in the elderly and scarce knowledge exists about factors that influence persistence in outpatient care. Our aim was to evaluate drug use and its predictors in survivors of AMI above 64 years from hos- pital discharge to 1-year post-AMI. Methods In a single-centre randomised controlled trial, discharge medication of 259 patients with AMI was obtained from medical records at hospital stay. Follow-up drug use and use of the healthcare system were self- reported to study nurses over 1 year in 3-month intervals. Predictors for persistence were modelled with multivariate logistic regression analysis considering demographics, co- morbidities and treatment characteristics. Results At discharge, 99.2 % of the patients used anti- platelets, 86.5 % beta blockers, 95.0 % statins and 90.4 % angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Use of the combination of all four drug classes decreased from discharge to 1 year post-AMI from 74.1 to 37.8 % and was significantly reduced by age C75 years (odds ratio [OR] 0.49; 95 % confidence interval [CI] 0.29–0.85) and ten or more visits with general prac- titioners (GPs) over 1 year (OR 0.29; 95 % CI 0.17–0.51). Persistence from month 3 to 12 was significantly associated with drug use at discharge for the single drug classes, but not for the drug combination. Conclusion Older age and frequent GP visits are associ- ated with decreased use of the guideline-recommended drug combination after AMI. Further research is needed to specify underlying reasons and develop measures to improve persistence. Key Points Anti-platelets, beta blockers, statins and angiotensin- converting enzyme inhibitors/angiotensin receptor blockers were prescribed to 74.1 % of elderly patients with myocardial infarction at hospital discharge, but their use significantly decreased to 37.8 % during 1 year follow-up. Patients who were 75 years or older or had ten or more visits with a general practitioner were less likely to receive all four secondary prevention drugs 1 year after myocardial infarction. Electronic supplementary material The online version of this article (doi:10.1007/s40266-014-0189-x) contains supplementary material, which is available to authorized users. S. Al-Khadra Á C. Meisinger Á U. Amann Á I. Kirchberger (&) Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany e-mail: inge.kirchberger@helmholtz-muenchen.de S. Al-Khadra Á C. Meisinger Á U. Amann Á I. Kirchberger Helmholtz Zentrum Mu ¨nchen, German Research Center for Environmental Health (GmbH), Institute of Epidemiology II, Neuherberg, Germany R. Holle Á H. Seidl Helmholtz Zentrum Mu ¨nchen, German Research Center for Environmental Health (GmbH), Institute of Health Economics and Health Care Management, Neuherberg, Germany B. Kuch Department of Internal Medicine/Cardiology, Hospital of No ¨rdlingen, No ¨rdlingen, Germany B. Kuch Department of Internal Medicine I, Cardiology, Central Hospital of Augsburg, Augsburg, Germany Drugs Aging (2014) 31:513–525 DOI 10.1007/s40266-014-0189-x