Outpatient adherence to beta-blocker therapy after acute myocardial infarction

doi:10.1016/S0735-1097(02)02379-3

Journal of the American College of Cardiology

Volume 40, Issue 9, 6 November 2002, Pages 1589-1595

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Abstract

Objectives

This study was designed to determine adherence to outpatient beta-blocker therapy following acute myocardial infarction (AMI).

Background

The importance of beta-blocker therapy after AMI is widely recognized. Outpatient adherence with this recommendation, however, is not well described.

Methods

Data on 846 patients surviving AMI were studied. Factors associated with filling a beta-blocker prescription within 30 days postdischarge and the proportion of patients who were or were not discharged on beta-blockers who filled prescriptions for them by 30, 180, and 365 days post-AMI discharge were assessed.

Results

Patients with a discharge order for beta-blocker therapy were more likely to fill a prescription in the first 30 days postdischarge (hazard ratio [HR] 15.82, 95% confidence interval [CI], 10.75 to 23.26). Patients older than age 75 years were less likely than those age <65 years to fill a prescription (HR 0.63, 95% CI 0.42 to 0.93). Gender, race, and being an ideal candidate did not affect beta-blocker use. Among patients who were discharged on beta-blockers, 85% of survivors had filled a prescription by 30 days postdischarge, and 63% and 61% were current users at 180 and 365 days, respectively. In contrast, only 8% of those patients with no discharge order for beta-blockers had filled such a prescription by 30 days, and 13% and 12% of patients were current users at 180 and 365 days, respectively.

Conclusions

Patients not discharged on beta-blockers are unlikely to be started on them as outpatients. For patients who are discharged on beta-blockers after AMI, there is a significant decline in use after discharge. Quality improvement efforts need to be focused on improving discharge planning and to continue these efforts after discharge.

Abbreviations

ACC

American College of Cardiology

AHA

American Heart Association

AMI

acute myocardial infarction

confidence intervals

hazard ratio

LVEF

left ventricular ejection fraction

relative risk

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Supported in part by an Agency for Healthcare Research and Quality, Centers for Education and Research in Therapeutics cooperative agreement (grant #HS 1-0384), and a cooperative agreement with the Food and Drug Administration (FD-U-001641).

The analyses upon which this publication is based were performed under Contract Number 500-99-TN01, entitled “Utilization and Quality Control Quality Improvement Organization for the State of Tennessee,” sponsored by the Centers for Medicare and Medicaid Services, Department of Health and Human Services. The content of this publication does not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government.

The authors assume full responsibility for the accuracy and completeness of the ideas presented. This article is a direct result of the Health Care Quality Improvement Program initiated by the Centers for Medicare and Medicaid Services, which has encouraged identification of quality improvement projects derived from analysis of patterns of care. Ideas and contributions to the authors concerning experience in engaging with issues presented are welcomed.