CLINICAL STUDY: ACUTE MYOCARDIAL INFARCTION
Outpatient adherence to beta-blocker therapy after acute myocardial infarction
Javed Butler, MD, MPH, FACC*  ||,*,
Patrick G. Arbogast, PhD ,
Rhonda BeLue, PhD,
James Daugherty, MS,
Manoj K. Jain, MD, MPH,
Wayne A. Ray, PhD|| and
Marie R. Griffin, MD, MPH||
* Department of Medicine, Cardiology Division, Nashville, Tennessee, USA
Center for Health Services Research, Nashville, Tennessee, USA
Department of Preventive Medicine, Vanderbilt University, Nashville, Tennessee, USA
Center for Healthcare Quality, Inc, Nashville, Tennessee, USA
|| Geriatrics Research, Education, and Clinical Center, Nashville VA Medical Center, Nashville, Tennessee, USA
Manuscript received April 2, 2002;
revised manuscript received July 19, 2002,
accepted July 24, 2002.
* Reprint requests and correspondence: Dr. Javed Butler, Cardiology Division, 383-PRB, Vanderbilt University Medical Center, Nashville, Tennessee 37232, USA.
javed.butler{at}vanderbilt.edu
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.
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Abbreviations and Acronyms
| | ACC | | American College of Cardiology | | AHA | | American Heart Association | | AMI | | acute myocardial infarction | | CI | | confidence intervals | | HR | | hazard ratio | | LVEF | | left ventricular ejection fraction | | RR | | relative risk |
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