Use and adherence to beta‐blockers for secondary prevention of myocardial infarction: who is not getting the treatment?

Li, Wei; Flynn, Robert; Murray, Gordon D.; MacDonald, Thomas M.

doi:10.1002/pds.963

Cited by 47 publications

(47 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A few studies extend their follow-up to 1 year. 7,9,10,21,22 Yet, in our study population, there is no sign of leveling in the discontinuation rates after 1 year post-AMI. We identified two studies examining adherence beyond the first year post-AMI, 8,11 which have limited generalizability, and more importantly, examine Figure 2.…”

Section: Discussioncontrasting

confidence: 58%

“…4 Limited data suggest that many patients who initiated these regimes after AMI have low rates of longterm persistence. [7][8][9][10] Beta-blocker or ACEI therapies are indicated for other diseases (e.g., coronary artery disease and hypertension), and studies following patients with such conditions also demonstrated low long-term adherence rates. [10][11][12][13][14][15] To identify subpopulations at greatest risk of therapy discontinuation, this study used administrative data from a large U.S. health plan to describe patient characteristics and comorbidities associated with increased rates of therapy discontinuation during the 2 years after AMI.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Long-Term Adherence to Evidence Based Secondary Prevention Therapies after Acute Myocardial Infarction

et al. 2007

View full text Add to dashboard Cite

BACKGROUND: After acute myocardial infarction (AMI), treatment with beta-blockers and angiotensinconverting enzyme inhibitors (ACEI) is widely recognized as crucial to reduce risk of a subsequent AMI. However, many patients fail to consistently remain on these treatments over time, and long-term adherence has not been well described. OBJECTIVE:To examine the duration of treatment with beta-blockers and ACEI within the 24 months after an AMI. DESIGN:A retrospective, observational study using medical and pharmacy claims from a large health plan operating in the Northeastern United States. SUBJECTS:Enrollees with an inpatient claim for AMI who initiated beta-blocker (N=499) or ACEI (N=526) therapy.MEASUREMENT: Time from initiation to discontinuation was measured with pharmacy refill records. Associations between therapy discontinuation and potential predictors were estimated using a Cox proportional hazards model. RESULTS: ACEI discontinuation rates were high: 7% stopped within 1 month, 22% at 6 months, 32% at 1 year and 50% at 2 years. Overall discontinuation rates for beta-blockers were similar, but predictors of discontinuation differed for the two treatment types. For beta-blockers, the risk of discontinuation was highest among males and those from low-income neighborhoods; patients with comorbid hypertension and peripheral vascular disease were less likely to discontinue therapy. These factors were not associated with ACEI discontinuation.CONCLUSION: Many patients initiating evidence-based secondary prevention therapies after an AMI fail to consistently remain on these treatments. Adherence is a priority area for development of better-quality measures and quality-improvement interventions. Barriers to beta-blocker adherence for low-income populations need particular attention.

show abstract

Section: Discussioncontrasting

confidence: 58%

Section: Introductionmentioning

confidence: 99%

Long-Term Adherence to Evidence Based Secondary Prevention Therapies after Acute Myocardial Infarction

et al. 2007

View full text Add to dashboard Cite

show abstract

“…Comparison with other studies is not straightforward; the literature on sex-based disparities in adherence to cardiovascular drugs is mixed and results vary by drug class; some studies show that women have better adherence to angiotensin-converting enzyme inhibitor/angiotensin receptor blockers and BBs 31 or statins, 32 whereas others reveal that men have better adherence to statins, [33][34][35][36] BBs, 31,37 and aspirin. 34,38 This between-study variation may be partially attributable to the structure of the healthcare system and drug reimbursement, differences in prescribing practices across jurisdictions, and differences in adherence measurement.…”

Section: Adherence To Pharmacotherapymentioning

confidence: 99%

Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

Smolina

Ball

Humphries

et al. 2015

Circ: Cardiovascular Quality and Outcomes

View full text Add to dashboard Cite

Background— The prevalence of the use of secondary prevention cardiovascular medications is lower among women than men, but it is unclear if this is a result of lower treatment initiation among women or lower treatment adherence. We aimed to map the treatment pathway for survivors of acute myocardial infarction (AMI) by sex and age. Methods and Results— This retrospective population-based cohort study used linked administrative data sets in British Columbia (2004–2011), which include health care, prescription drugs, sociodemographic, and mortality information. The study cohort included all individuals admitted to hospital for AMI in 2007–2009 and survived for 1 year after hospital discharge. Patients were evaluated for whether they initiated and then subsequently filled prescriptions angiotensin-converting enzyme inhibitors, β-blockers, and statins. More than two thirds of AMI survivors initiated treatment on all appropriate medications, given their contraindications, within 2 months of discharge. Younger men were significantly more likely than younger women to initiate appropriate treatment (adjusted odds ratio, 1.38; 95% confidence interval, 1.10–1.75). By the end of 1 year after discharge, only one third of all AMI survivors filled all appropriate prescriptions for at least 80% of the year. There was no significant difference in adherence to medication therapy between women and men. Conclusions— The majority of AMI survivors either discontinue treatment or do not refill their prescriptions consistently. Women <55 years are significantly less likely to be on optimal therapy by the end of 1 year after discharge, which is driven by a sex disparity in treatment initiation and not treatment adherence.

show abstract

“…However, post-AMI beta-blocker therapy is often underutilized [6][7][8][9][10]. Only 61% of patients who were candidates for post-AMI beta-blocker therapy actually initiated it in British Columbia, Canada, between 2001 and 2004 [9].…”

Section: Introductionmentioning

confidence: 99%

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

Maio

Marino

Robeson

et al. 2011

European Journal of Cardiovascular Prevention & Rehabilitat

View full text Add to dashboard Cite

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.

show abstract

Use and adherence to beta‐blockers for secondary prevention of myocardial infarction: who is not getting the treatment?

Abstract: Beta-blocker use was lower in older patients, patients with airways disease, PVD and heart failure, but these patients appeared to have the greatest benefit from beta-blockers. Good adherence to beta-blocker treatment after MI was associated with a lower risk of mortality.

Cited by 47 publications

References 30 publications

Long-Term Adherence to Evidence Based Secondary Prevention Therapies after Acute Myocardial Infarction

Long-Term Adherence to Evidence Based Secondary Prevention Therapies after Acute Myocardial Infarction

Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence

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

Contact Info

Product

Resources

About