|
|
||||||||||
|
J Am Coll Cardiol, 2002; 40:1589-1595 © 2002 by the American College of Cardiology Foundation |

||,*



||
||
* 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.
| ||||||||||||||||
This article has been cited by other articles:
![]() |
G. C. Fonarow, W. T. Abraham, N. M. Albert, W. G. Stough, M. Gheorghiade, B. H. Greenberg, C. M. O'Connor, J. L. Sun, C. W. Yancy, J. B. Young, et al. Influence of Beta-Blocker Continuation or Withdrawal on Outcomes in Patients Hospitalized With Heart Failure: Findings From the OPTIMIZE-HF Program J. Am. Coll. Cardiol., July 15, 2008; 52(3): 190 - 199. [Abstract] [Full Text] [PDF] |
||||
![]() |
R. Auer, J. Gaume, N. Rodondi, J. Cornuz, and W. A. Ghali Efficacy of In-Hospital Multidimensional Interventions of Secondary Prevention After Acute Coronary Syndrome: A Systematic Review and Meta-Analysis Circulation, June 17, 2008; 117(24): 3109 - 3117. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. H. Smith, J. M. Kramer, N. Perrin, R. Platt, D. W. Roblin, K. Lane, M. Goodman, W. W. Nelson, X. Yang, and S. B. Soumerai A Randomized Trial of Direct-to-Patient Communication to Enhance Adherence to {beta}-Blocker Therapy Following Myocardial Infarction Arch Intern Med, March 10, 2008; 168(5): 477 - 483. [Abstract] [Full Text] [PDF] |
||||
![]() |
E. S. Ford, U. A. Ajani, J. B. Croft, J. A. Critchley, D. R. Labarthe, T. E. Kottke, W. H. Giles, and S. Capewell Explaining the Decrease in U.S. Deaths from Coronary Disease, 1980-2000 N. Engl. J. Med., June 7, 2007; 356(23): 2388 - 2398. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. T. Ko, H. M. Krumholz, Y. Wang, J. M. Foody, F. A. Masoudi, E. P. Havranek, J. J. You, D. A. Alter, T. A. Stukel, A. M. Newman, et al. Regional Differences in Process of Care and Outcomes for Older Acute Myocardial Infarction Patients in the United States and Ontario, Canada Circulation, January 16, 2007; 115(2): 196 - 203. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Butler, J. B. Young, W. T. Abraham, R. C. Bourge, K. F. Adams Jr, R. Clare, C. O'Connor, and for the ESCAPE Investigators Beta-Blocker Use and Outcomes Among Hospitalized Heart Failure Patients J. Am. Coll. Cardiol., June 20, 2006; 47(12): 2462 - 2469. [Abstract] [Full Text] [PDF] |
||||
![]() |
R J Shelton, A S Rigby, J G F Cleland, and A L Clark Effect of a community heart failure clinic on uptake of {beta} blockers by patients with obstructive airways disease and heart failure Heart, March 1, 2006; 92(3): 331 - 336. [Abstract] [Full Text] [PDF] |
||||
![]() |
L. K. Newby, N. M. Allen LaPointe, A. Y. Chen, J. M. Kramer, B. G. Hammill, E. R. DeLong, L. H. Muhlbaier, and R. M. Califf Long-Term Adherence to Evidence-Based Secondary Prevention Therapies in Coronary Artery Disease Circulation, January 17, 2006; 113(2): 203 - 212. [Abstract] [Full Text] [PDF] |
||||
![]() |
D. T. Ko, J. V. Tu, F. A. Masoudi, Y. Wang, E. P. Havranek, S. S. Rathore, A. M. Newman, L. R. Donovan, D. S. Lee, J. M. Foody, et al. Quality of Care and Outcomes of Older Patients With Heart Failure Hospitalized in the United States and Canada Arch Intern Med, November 28, 2005; 165(21): 2486 - 2492. [Abstract] [Full Text] [PDF] |
||||
![]() |
K. M O'Dell and S. N Kucukarslan Impact of the Clinical Pharmacist on Readmission in Patients with Acute Coronary Syndrome Ann. Pharmacother., September 1, 2005; 39(9): 1423 - 1427. [Abstract] [Full Text] [PDF] |
||||
![]() |
T A McDonagh Lessons from the management of chronic heart failure Heart, May 1, 2005; 91(suppl_2): ii24 - ii27. [Abstract] [Full Text] [PDF] |
||||
![]() |
G Hanania, J-P Cambou, P Gueret, L Vaur, D Blanchard, J-M Lablanche, Y Boutalbi, R Humbert, P Clerson, N Genes, et al. Management and in-hospital outcome of patients with acute myocardial infarction admitted to intensive care units at the turn of the century: results from the French nationwide USIC 2000 registry Heart, December 1, 2004; 90(12): 1404 - 1410. [Abstract] [Full Text] [PDF] |
||||
![]() |
J. Butler, P. G. Arbogast, J. Daugherty, M. K. Jain, W. A. Ray, and M. R. Griffin Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge J. Am. Coll. Cardiol., June 2, 2004; 43(11): 2036 - 2043. [Abstract] [Full Text] [PDF] |
||||
![]() |
A. Halkin, C. L. Grines, D. A. Cox, E. Garcia, R. Mehran, J. E. Tcheng, J. J. Griffin, G. Guagliumi, B. Brodie, M. Turco, et al. Impact of intravenous Beta-Blockade before primary angioplasty on survival in patients undergoing mechanical reperfusion therapy for acute myocardial infarction J. Am. Coll. Cardiol., May 19, 2004; 43(10): 1780 - 1787. [Abstract] [Full Text] [PDF] |
||||
| HOME | SUBSCRIPTIONS | CURRENT ISSUE | PAST ISSUES | CARDIOSOURCE | SEARCH | HELP | FEEDBACK |