Beta-blocker initiation and adherence after hospitalization for acute myocardial infarction

Abstract

Aims: We sought to: (1) estimate the proportion of patients who initiated beta-blocker therapy after acute myocardial infarction (AMI) in Regione Emilia-Romagna (RER); (2) examine predictors of post-AMI beta-blocker initiation; and (3) assess adherence to such therapy. Methods and Results: Using healthcare claims data covering all of RER, we identified a cohort of 24,367 patients with a hospitalization for AMI between 2004 and 2007, who were discharged from the hospital alive and without contraindications to beta-blocker therapy. We estimated the proportion of eligible patients with at least one prescription for a beta-blocker following discharge and performed a multivariable logistic regression analysis to identify independent predictors of post-AMI beta-blocker initiation. We computed the proportion of days covered (PCD) as a measure of medication adherence at 6 and 12 months post-discharge. Following discharge, 16,383 (67%) cohort members initiated beta-blocker therapy. Independent predictors of beta-blocker initiation included age and receipt of invasive procedures during hospitalization, such as coronary artery bypass graft surgery (odds ratio [OR], 2.37; 95% confidence interval [CI], 2.00–2.81), percutaneous transluminal coronary angioplasty (OR, 1.42; 95% CI, 1.31–1.54), and cardiac catheterization (OR, 1.21; 95% CI, 1.11–1.32). Among initiators, adherence to beta-blocker treatment at 6 and 12 months was low and decreased in each study year. Conclusion: Overall, use of and adherence to post-AMI beta-blocker therapy was suboptimal in RER between 2004 and 2007. Older patients and those with indicators of frailty were less likely to initiate therapy. The proportion of patients adherent at 6 and 12 months decreased over time.

Adherence to evidence-based secondary prevention pharmacotherapy in patients after an acute coronary syndrome: A systematic review

“…Medication adherence at 1-year follow-up was higher in countries where universal health coverage existed. Risk factors associated with non-adherence were examined in a 24,26,27,29,30,33,35,37,38 limited number of studies, and the results varied across the medication classes assessed. Our findings of suboptimal medication adherence are similar to the results of a prior systematic review showing that about one third of patients with CHD did not adhere to effective cardiac medications after a median follow-up of 24 months.…”

“…The majority of participants in our included studies was white, though only 3 US-based studies 25,33,36 provided data on race/ ethnicity. Overall, 6 studies 23,26,29,31,36,37 examined the use of a single cardiac medication, while the other 10 studies 24,25,27,28,30,32e35,38 examined adherence to multiple cardiac drugs. The most common measures used for assessing medication adherence were proportion of days covered (PDC) (n ¼ 9), 24,26,27,29,30,33,35,37,38 followed by medication possession ratio (MPR) (n ¼ 5), 23,25,31,32,34 electronic medication monitors (n ¼ 1), 36 and self-reported data (n ¼ 1).…”

“…Two studies, which provided mean MPR 34 or mean PDC, 29 rather than specific numbers of achieving good medication adherence, were not included for assessing medication adherence. Table 3 presents the ranges of good adherence to several guideline-recommended medications from 14 studies, according to study country (US vs. non-US), follow-up time point (3, 6, 9, 12, and 30 months), and type of medication class (ACEIs/ARBs, Antiplatelet agents, Beta-blockers, and Lipid lowering agents).…”

“…The remaining 2 studies 28,36 reported on samples of patients with an ACS recruited from hospital-based settings, which were all prospective cohort studies. Seven of the articles included were USbased studies 23,25,28,31,33,34,36 and the non-US studies (n ¼ 9) were from Canada 27,35,38 and several European countries (i.e., UK, 37 Italy, 29,30 Spain, 24 France 26,32 ) with universal health coverage. Overall, 14 studies 23e27,29e35,37,38 used claims-based data to estimate medication adherence.…”

Self‐Controlled Case‐Series Study to Verify the Effect of Adherence to Beta‐Blockers in Secondary Prevention of Myocardial Infarction

“…We estimated the relative incidence rate ratios (IRR) using conditional Poisson regression with Stata software, version 13 (Stata Corp, College Station, TX). Although the observation period is relatively short, we preferred to adjust for possible intrapersonal time‐trends of both adherence (eg, decreasing with time 11 ) and re‐infarction risk (eg, increasing with time/age) by dividing the observation period in 2 semesters and adding this term to the model. In order to assess whether the risk was different in individuals treated or not with PCI, 11 we also evaluated in the model an interaction term PCI×exposure.…”