ArticleCJC open2026
Follow-up Dosing of Guideline-Indicated Medications After Myocardial Infarction: Insights from the Acute Myocardial Infarction Quality Assurance (AMIQA) Canada Study.
Article in CJC open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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5 authors.
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Abstract
Background: Achieving the target doses of indicated medications after myocardial infarction (MI) is associated with improved outcomes and is a marker of the quality of care. We studied the use and follow-up dosing of core cardiac medications among patients with MI complicated by depressed left ventricular ejection fraction (LVEF). Our objective was to determine whether adherence to evidence-based medication dosing is associated with receipt of follow-up LVEF imaging or progression of LVEF within 6 months of follow-up care. Methods: The Acute Myocardial Infarction Quality Assurance (AMIQA) Canada study enrolled 501 patients (mean age 63 years; 22.6% female) with acute MI and LVEF ≤ 45%, from 14 Canadian centres. Patients were followed for 6 months to determine their adherence to post-MI follow-up recommendations. We assessed use and dosing of beta-blockers, angiotension-converting enzyme inhibitors, angiotensin II receptor blockers, mineralocorticoid receptor antagonists (MRAs), and statins, and compared changes in LVEF among those taking ≥50% vs < 50% of the target dose in the follow-up period. Results: At 6 months, the mean percent target dose was ≤ 50% for beta-blockers, angiotension-converting enzyme inhibitors, and angiotensin II receptor blockers, but it was 70.8% ± 46.9% for MRAs, and 86.8% received high-intensity statin. Only use of MRA was associated with follow-up LVEF reassessment ( Conclusions: Except for statins, most patients were not receiving target doses of indicated medications after MI with reduced LVEF. Follow-up dosing was not associated with LVEF reassessment or improvement in LVEF. Future quality-improvement initiatives may require distinct strategies for improving adherence to recommendations for medication dosing vs follow-up imaging.
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