title: Outpatient adherence to beta-blocker therapy after acute myocardial infarction.
abstract: OBJECTIVE
  This study was designed to determine adherence to outpatient beta-blocker therapy following acute myocardial infarction (AMI).
  
  
  BACKGROUND
  The importance of beta-blocker therapy after AMI is widely recognized. Outpatient adherence with this recommendation, however, is not well described.
  
  
  METHODS
  Data on 846 patients surviving AMI were studied. Factors associated with filling a beta-blocker prescription within 30 days postdischarge and the proportion of patients who were or were not discharged on beta-blockers who filled prescriptions for them by 30, 180, and 365 days post-AMI discharge were assessed.
  
  
  RESULTS
  Patients with a discharge order for beta-blocker therapy were more likely to fill a prescription in the first 30 days postdischarge (hazard ratio [HR] 15.82, 95% confidence interval [CI], 10.75 to 23.26). Patients older than age 75 years were less likely than those age <65 years to fill a prescription (HR 0.63, 95% CI 0.42 to 0.93). Gender, race, and being an ideal candidate did not affect beta-blocker use. Among patients who were discharged on beta-blockers, 85% of survivors had filled a prescription by 30 days postdischarge, and 63% and 61% were current users at 180 and 365 days, respectively. In contrast, only 8% of those patients with no discharge order for beta-blockers had filled such a prescription by 30 days, and 13% and 12% of patients were current users at 180 and 365 days, respectively.
  
  
  CONCLUSIONS
  Patients not discharged on beta-blockers are unlikely to be started on them as outpatients. For patients who are discharged on beta-blockers after AMI, there is a significant decline in use after discharge. Quality improvement efforts need to be focused on improving discharge planning and to continue these efforts after discharge.
authors.affiliation: Department of Medicine, Cardiology Division, 383-PRB, Vanderbilt University Medical Center, Nashville, TN 37232, USA. javed.butler@vanderbilt.edu
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Patrick G
authors.initials: PG
authors.lastname: Arbogast
authors.forename: Rhonda
authors.initials: R
authors.lastname: BeLue
authors.forename: James
authors.initials: J
authors.lastname: Daugherty
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Jain
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Ray
authors.forename: Marie R
authors.initials: MR
authors.lastname: Griffin
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D015331:Cohort Studies; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D008297:Male; D006278:Medicare; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D010351:Patient Discharge; D013714:Tennessee
chemical_list: D000319:Adrenergic beta-Antagonists