Post-Myocardial Infarction Guideline-Recommended Therapy Utilizing Sankey Diagrams Among Medicare Beneficiaries

Area of Science:

• Cardiology
• Health Services Research
• Data Visualization

Background:

• Guideline-directed medical therapy (GDMT) and cardiac rehabilitation (CR) are crucial for secondary prevention after myocardial infarction (MI).
• Longitudinal patterns of participation in these therapies are complex and not fully understood.
• Visualizing these trends can reveal critical adherence gaps.

Purpose of the Study:

• To longitudinally describe patterns of guideline-directed medical therapy (GDMT) and cardiac rehabilitation (CR) participation for 2 years post-myocardial infarction (MI).
• To utilize Sankey diagrams for visualizing these complex patient pathways.
• To identify patient subgroups with suboptimal secondary prevention adherence.

Main Methods:

• Analysis of Medicare beneficiaries (aged 66-95) hospitalized with acute MI between January 2014 and September 2015.
• Definition of GDMT as a 21-day supply of ACE-inhibitor/ARB, statin, and beta-blocker within a 30-day window.
• Stratification of CR participation by days with claims (1-11, 12-23, ≥24) and visualization using Sankey diagrams.

Main Results:

• Of 5793 beneficiaries, 45% initiated CR within 30 days post-MI.
• At 1 year, 33-37% of patients concluded CR early, with higher rates in those without pre-MI GDMT.
• Medication nonadherence post-MI ranged from 2-16%, with 4-5% monthly switching between GDMT classes.

Conclusions:

• Sankey diagrams effectively illustrate longitudinal patterns of GDMT and CR utilization post-MI.
• Identified intervention populations include those with inconsistent CR participation and medication nonadherence.
• These visualizations aid in understanding and addressing challenges in secondary prevention.