{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T16:53:51Z","timestamp":1788886431120,"version":"build-2803163510"},"reference-count":36,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"am","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003793","name":"Swedish Heart and Lung Foundation","doi-asserted-by":"publisher","award":["20190390"],"award-info":[{"award-number":["20190390"]}],"id":[{"id":"10.13039\/501100003793","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000925","name":"National Health and Medical Research Council","doi-asserted-by":"publisher","award":["GNT1135920"],"award-info":[{"award-number":["GNT1135920"]}],"id":[{"id":"10.13039\/501100000925","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100009021","name":"Heart Research Australia","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100009021","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We examine persistence with secondary prevention medication and longer-term mortality in a population-level cohort of ST-elevation myocardial infarction (STEMI) patients with and without standard modifiable cardiovascular risk factors (SMuRFs; hypertension, diabetes, hypercholesterolaemia, smoking).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We utilized landmark analysis to study 65 059 first-time STEMI patients from the SWEDEHEART registry who were prescribed aspirin, lipid-lowering therapy (LLT), renin\u2013angiotensin\u2013aldosterone system (RAAS) inhibitors, or beta-blockers at hospital discharge. Persistence was assessed as a binary variable in patients alive 12 months after first dispensation (initiation, the landmark). The primary outcome was all-cause mortality 3 years after the 12-month landmark. Multivariable logistic regression models and Kaplan\u2013Meier analyses were used to compare persistence, and Cox proportional hazards models to assess the impact of persistence on mortality. At 4 years after pharmacotherapy initiation, &amp;gt;50% of patients had discontinued prescribed aspirin, LLT, RAAS inhibitor, or beta-blocker. SMuRF-less patients were less likely to receive medications at hospital discharge; however, if prescribed, they were more likely to be persistent with aspirin and LLT at 12 months compared to SMuRF-positive patients. Discontinuing aspirin, LLT, or RAAS inhibitors within 12 months after initiation was associated with increased all-cause mortality 3 years later in both groups (HR between 1.45 and 2.02). Beta-blocker discontinuation was not associated with mortality in either group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Persistence with secondary prevention medication declined rapidly in this cohort. The increased longer-term mortality associated with 12-month non-persistence highlights the need to better understand drivers of medication discontinuation, and to work with patients and clinicians to support consistent use of guideline-recommended medications, regardless of risk factor status.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/eurjpc\/zwag421","type":"journal-article","created":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T11:23:56Z","timestamp":1787570636000},"source":"Crossref","is-referenced-by-count":1,"title":["Medication persistence and mortality in ST-elevation myocardial infarction patients with and without standard modifiable risk factors: a SWEDEHEART registry study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9543-1991","authenticated-orcid":false,"given":"Suzanne R","family":"Avis","sequence":"first","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]},{"name":"Kolling Institute, Royal North Shore Hospital , 10 Westbourne St, St Leonards, NSW 2065 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9368-6325","authenticated-orcid":false,"given":"Nermin","family":"Hadziosmanovic","sequence":"additional","affiliation":[{"name":"Uppsala Clinical Research Centre , Uppsala ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P","family":"Gray","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]},{"name":"Kolling Institute, Royal North Shore Hospital , 10 Westbourne St, St Leonards, NSW 2065 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6262-0916","authenticated-orcid":false,"given":"Stephen T","family":"Vernon","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]},{"name":"Kolling Institute, Royal North Shore Hospital , 10 Westbourne St, St Leonards, NSW 2065 ,","place":["Australia"]},{"name":"Department of Cardiology, Royal North Shore Hospital , Reserve Road, St Leonards, NSW 2065 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1902-9113","authenticated-orcid":false,"given":"Thomas","family":"Buckley","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Margr\u00e9t","family":"Le\u00f3sd\u00f3ttir","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Faculty of Medicine, Lund University , Malm\u00f6 ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1415-7178","authenticated-orcid":false,"given":"Joakim","family":"Alfredsson","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Link\u00f6ping University , Link\u00f6ping ,","place":["Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4693-0038","authenticated-orcid":false,"given":"Clara K","family":"Chow","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health, University of Sydney , Sydney, NSW 2006 ,","place":["Australia"]},{"name":"Westmead Applied Research Centre, University of Sydney , Sydney ,","place":["Australia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emil","family":"Hagstrom","sequence":"additional","affiliation":[{"name":"Department of Medical Sciences, Uppsala University , Uppsala 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