Postdischarge Follow-up After AMI and Medication Adherence

Study Questions:

Is earlier outpatient follow-up after acute myocardial infarction (AMI) associated with higher rates of medication adherence?

Methods:

This was a retrospective analysis of 20,976 Medicare patients, >65 years of age, discharged alive after an AMI between 2007 and 2010, from hospitals voluntarily participating in the Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines (ACTION Registry-GWTG). The first outpatient clinic visit was defined as the first appointment after hospital discharge with either a cardiology, primary care, internal medicine, or family practice health care professional. Patients were grouped based on the timing of first follow-up clinical visit within 1 week, 1-2 weeks, 2-6 weeks, or >6 weeks after hospital discharge. Primary outcomes of interest were medication adherence at 90 days and 1 year from discharge. Medication adherence was defined using Medicare Part D prescription fill data as the proportion of days covered of ≥80% for each medication.

Results:

The median time to the first outpatient follow-up visit after hospital discharge was 14 days (interquartile range, 7-28 days). Among the 20,332 first follow-up visits, 9,693 (47.7%) were with a cardiologist. Rates of medication adherence for secondary prevention therapies ranged from 63.4% to 68.7% at 90 days, and 54.4% to 63.5% at 1 year. Compared with patients with follow-up visits within 1 week, those with follow-up in 1-2 weeks and 2-6 weeks had no significant difference in medication adherence; however, patients with follow-up >6 weeks after discharge had lower adherence at both 90 days (56.8%-61.3% vs. 64.7%-69.3%; p < 0.001) and 1 year (49.5%-57.7% vs. 55.4%-64.1%; p < 0.001). In adjusted analyses, delayed follow-up (>6 weeks) was associated with lower medication adherence at 90 days (odds ratio [OR], 0.74; 95% confidence interval [CI], 0.70-0.78) and 1 year (OR, 0.79; 95% CI, 0.73-0.85) compared with follow-up of ≤6 weeks.

Conclusions:

Delayed outpatient follow-up after AMI (>6 weeks) is associated with lower medication adherence at 90 days and 1 year, compared to follow-up before 6 weeks.

Perspective:

This is an important study that establishes the benefits of early follow-up within 6 weeks of discharge following AMI. Such early discharge is associated with greater 90-day and 1-year medication adherence. That said, and as the authors emphasize, almost one in three patients were no longer adherent to evidence-based medications prescribed at discharge as early as 90 days after AMI. This is certainly a call to action to address medication adherence. Strategies such as early follow-up may help improve adherence and potentially improve outcomes.

Clinical Topics: Acute Coronary Syndromes, Geriatric Cardiology, Prevention

Keywords: ACTION Registry-GWTG, Acute Coronary Syndrome, Geriatrics, Medicare Part D, Medication Adherence, Myocardial Infarction, Outpatients, Patient Discharge, Secondary Prevention


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