# Saudi Secondary Prevention Survey Study in Patients with Prior Acute Myocardial Infarction (4S Registry): Study Design and Pilot Phase Results

## TL;DR

A Saudi study found that most heart attack survivors fail to meet recommended health targets for preventing future issues.

## Contribution

The study provides pilot data on secondary prevention gaps in Saudi AMI patients using a multicenter cohort design.

## Key findings

- Over half of patients had uncontrolled blood pressure and 67% had elevated LDL-C levels.
- Most participants were overweight or obese, and only 28.7% met physical activity targets.
- One-third of patients were not receiving all guideline-directed medical therapies.

## Abstract

Patients with prior acute myocardial infarction (AMI) generally show low rates of achieving secondary prevention targets. Here we evaluated adherence to guideline-recommended secondary prevention strategies after AMI in Saudi Arabia. This ambispective multicenter cohort study included consecutive patients seen for follow-up visits 6–24 months after hospitalization for AMI. A standardized questionnaire was used to evaluate control of blood pressure (<130/80 mmHg), HbA1c (<7%), LDL-C (<1.4 mmol/L), lipoprotein(a) (<50 mg/dL), body mass index (18.5–24.9 kg/m2), physical activity targets, smoking habits, guideline-directed medical therapy (GDMT), and referral to cardiac rehabilitation. Among 108 AMI patients (mean age 58.4 ± 10.9 years; 80.6% male; 76.9% Saudi nationals), 53.7% had uncontrolled blood pressure, ~40% uncontrolled glucose, and 67% above-target LDL-C levels. Most participants were overweight (40.7%) or obese (37%), and 28.7% achieved the physical activity targets. One-third of patients were not receiving all GDMT, 15.7% were current smokers, and 25% had been referred to cardiac rehabilitation. No patient met all guideline-recommended secondary prevention targets. This pilot study highlights gaps in secondary prevention among AMI survivors. Upcoming study phases will aim for national representation and help identify key clinical and demographic drivers to improve secondary prevention efforts across Saudi Arabia.