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Does the presence of heart failure alter prescribing of drug therapy after myocardial infarction?

Lauren J Bailey and Vasi Naganathan
Med J Aust 2007; 186 (2): . || doi: 10.5694/j.1326-5377.2007.tb00817.x
Published online: 15 January 2007

To the Editor: In a recent observational study, Krum et al concluded that the treatment of heart failure after myocardial infarction in Australian teaching hospitals is suboptimal because angiotensin-converting enzyme (ACE) inhibitors, β-blockers and aldosterone antagonists are underutilised.1 We believe that another explanation, mentioned by the study’s authors, is worth exploring further — for valid clinical reasons, it was not appropriate for certain patients to start or continue taking some of these medications. An understanding of the enrolment criteria of relevant clinical trials is informative.


  • Concord General Repatriation Hospital, Sydney, NSW.



  • 1. Krum H, Meehan A, Varigos J, et al. Does the presence of heart failure alter prescribing of drug therapy after myocardial infarction? A multicentre study. Med J Aust 2006; 185: 191-194. <MJA full text>
  • 2. Moye LA, Pfeffer MA, Braunwald E. Rationale, design and baseline characteristics of the survival and ventricular enlargement trial. SAVE Investigators. Am J Cardiol 1991; 68: 70D-79D.
  • 3. The Trace Study Group. The TRAndolapril Cardiac Evaluation (TRACE) study: rationale, design, and baseline characteristics of the screened population. Am J Cardiol 1994; 73: 44C-50C.
  • 4. The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators. Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993; 342: 821-828.
  • 5. Dargie HJ. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001; 357: 1385-1390.
  • 6. Juurlink DN, Mamdani MM, Lee DS, et al. Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study. N Engl J Med 2004; 351: 543-551.

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