Durham, NC—How well acute myocardial infarction (AMI) patients adhere to their medications is related to how quickly they receive outpatient follow-up after the incident.
That’s according to a new study in JAMA Cardiology. Researchers from the Duke Clinical Research Institute and colleagues looked at whether earlier outpatient follow-up after AMI is associated with patients better following drug regimens.
Background information in the articles notes that, with about 1 million Americans hospitalized for AMI annually, about 470,000 are expected to have a recurrent major adverse cardiovascular event.
To prevent that, current guidelines recommend regular use of specific medications, such as aspirin and statins, which have demonstrated long-term survival benefits for post–AMI patients.
Yet nonadherence to those medications is common following AMI, leading to efforts to incorporate strategies into provider payment models and national quality improvement guidelines, such as early outpatient follow-up for hospitalized patients.
For the study, researchers analyzed information on 20,976 Medicare patients older than 65 years discharged after an AMI from 461 U.S. hospitals associated with the Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines.
Based on the timing of the first follow-up clinic visit, patients were placed into one of four groups: within 1 week, 1 to 2 weeks, 2 to 6 weeks, or more than 6 weeks after hospital discharge.
Results indicate that the median time to the first outpatient follow-up visit after hospital discharge was 14 days, with the first follow-up clinic visit occurring 1 week or less after discharge in 26% of patients and 1 to 2 weeks in 25%. At the same time, 33% of patients didn’t have a follow up until between 2 and 6 weeks, and 16% had to wait more than 6 weeks.
Rates of medication adherence for secondary prevention therapies, meanwhile, ranged from 63% to 69% at 90 days and 54% to 64% at 1 year. Medication adherence was defined as the proportion of days with more than 80% coverage using Medicare Part D prescription fill records and was examined at 90 days and 1 year after discharge for beta blockers, platelet P2Y12 receptor inhibitors, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
No significant difference in medication adherence was detected among patients with follow-up visits within 1 week, 1 to 2 weeks or 2 to 6 weeks. Patients with follow-up more than 6 weeks after discharge, however, had lower adherence at both 90 days and 1 year.
In addition, follow-up delayed more than 6 weeks was associated with lower medication adherence at 90 days and 1 year compared with follow-up of 6 weeks or less, according to the results.
“These data support the concept that medication adherence is modifiable via improved care transitions,” study authors conclude.
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