National evaluation of adherence to beta-blocker therapy for 1 year after acute myocardial infarction in patients with commercial health insurance.

Journal Article (Journal Article;Multicenter Study)

BACKGROUND: Quality measures of evidence-based medications post-myocardial infarction have focused on prescription at hospital discharge. Yet survival benefits of these medications are best realized with sustained therapy. We sought to examine long-term beta-blocker adherence over the first year after myocardial infarction in patients with commercial health insurance and prescription drug benefits. METHODS: This multicenter analysis examined health plan records from members of 11 health plans who had myocardial infarction in 2001, survived at least 1 year, and maintained insurance coverage (N = 17,035). The primary outcome measure was adherence to beta-blockers (defined as prescription claims covering > or = 75% of days) for 360 days post-discharge. We also examined associations with adherence--time from discharge, health plan product (commercial or Medicare + Choice [M + C]), age (35-64 or > or = 65), sex, and region. RESULTS: For 360 days after discharge, only 45% of patients were adherent to beta-blockers, with the biggest drop in adherence between 30 and 90 days. In a multivariable model, statistically significant predictors of lower adherence were participation in M + C product, residence in the Southeast, and age (driven by young participants in M + C and young females in commercial products). CONCLUSIONS: In a population of patients with health insurance and prescription drug coverage, adherence to beta-blocker therapy in the first year after myocardial infarction is poor, indicating that factors other than medication cost are important determinants of long-term adherence. Quality improvement initiatives focused on long-term adherence are needed to realize maximal benefit from medical therapy in post-myocardial infarction patients.

Full Text

Duke Authors

Cited Authors

  • Kramer, JM; Hammill, B; Anstrom, KJ; Fetterolf, D; Snyder, R; Charde, JP; Hoffman, BS; Allen LaPointe, N; Peterson, E

Published Date

  • September 2006

Published In

Volume / Issue

  • 152 / 3

Start / End Page

  • 454.e1 - 454.e8

PubMed ID

  • 16923412

Electronic International Standard Serial Number (EISSN)

  • 1097-6744

Digital Object Identifier (DOI)

  • 10.1016/j.ahj.2006.02.030


  • eng

Conference Location

  • United States