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Outpatient adherence to beta-blocker therapy after acute myocardial infarction
Javed Butler1, Patrick G Arbogast, Rhonda BeLue
1Department of Medicine, Cardiology Division, 383-PRB, Vanderbilt University Medical Center, Nashville, TN 37232, USA. javed.butler@vanderbilt.edu
Insights
Adherence to beta-blocker therapy after acute myocardial infarction (AMI) is low. Patients discharged without beta-blockers rarely start them, and use declines significantly post-discharge, necessitating improved care transitions.
Area of Science:
- Cardiology
- Pharmacology
- Health Services Research
Background:
- Beta-blocker therapy is crucial post-acute myocardial infarction (AMI).
- Outpatient adherence to beta-blocker therapy after AMI is not well-documented.
- Understanding adherence patterns is vital for optimizing patient outcomes.
Purpose of the Study:
- To determine outpatient beta-blocker therapy adherence following acute myocardial infarction (AMI).
- To identify factors influencing beta-blocker prescription filling post-AMI.
- To assess long-term beta-blocker use patterns in AMI survivors.
Main Methods:
- Analysis of data from 846 patients surviving AMI.
- Assessment of factors associated with filling beta-blocker prescriptions within 30 days post-discharge.
- Evaluation of prescription filling rates at 30, 180, and 365 days post-discharge.
Main Results:
- Patients with a discharge order for beta-blockers were significantly more likely to fill prescriptions (HR 15.82).
- Older patients (age >75) were less likely to fill prescriptions compared to younger patients (HR 0.63).
- Among patients discharged on beta-blockers, 85% filled prescriptions by 30 days, but use declined to 61% by 365 days. Only 8% of patients not discharged on beta-blockers filled prescriptions by 30 days.
Conclusions:
- Patients not discharged on beta-blockers are unlikely to initiate therapy outpatient.
- Significant decline in beta-blocker use is observed among AMI survivors post-discharge.
- Quality improvement initiatives should focus on enhancing discharge planning and post-discharge follow-up for beta-blocker therapy.
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.