Outcomes of inappropriate prescribing of beta-blockers after an acute myocardial infarction in a Medicaid population.
BACKGROUND
Acute myocardial infarction (AMI) is associated with high mortality. beta-Blockers are known to reduce mortality and reinfarction rates when used for long-term prevention following an AMI.


OBJECTIVE
To assess the prescribing patterns of beta-blockers in patients after experiencing an AMI in the West Virginia Medicaid program and examine its impact on patient outcomes.


METHODS
One-year pre- and post-AMI data were extracted for 488 Medicaid patients. Prescribing of beta-blockers within 90 days after discharge was evaluated among these patients. Based on American Heart Association/American College of Cardiology guidelines, patients were divided into 2 groups: those prescribed therapy appropriately and those prescribed therapy inappropriately (underuse, misuse). One-year all-cause mortality, cardiac mortality, and cardiac morbidity were compared between the groups using survival analysis.


RESULTS
Approximately 64% of the patients were appropriately prescribed beta-blockers and illustrated significantly (p = 0.035) lower all-cause mortality rates compared with the inappropriately prescribed group at the one-year follow-up. Cardiac mortality evaluation showed no significant findings. The groups differed significantly in morbidity outcome (time to first cardiac hospitalization), with the inappropriate group exhibiting later hospitalization at the end of the year (p = 0.019). However, the appropriate group had a higher proportion of hypertensive patients, suggesting more severity compared with the inappropriate group.


CONCLUSIONS
Inappropriate prescribing of beta-blockers following AMI was observed in this Medicaid population. Data suggest that there were overall survival benefits associated with appropriate beta-blocker prescribing. However, cardiac morbidity associated with inappropriate prescribing needs to be evaluated after adjusting for disease severity between the 2 groups.
Fernandes
Ancilla W
AW
Global Health Outcomes, GlaxoSmithKline, Collegeville, PA, USA. ancilla.w.fernandes@gsk.com
Madhavan
S Suresh
SS
Amonkar
Mayur M
MM
Bell
Dawn
D
Islam
Syed S
SS
Scott
Virginia G
VG
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D015331:Cohort Studies; D011307:Drug Prescriptions; D004363:Drug Utilization; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology / Q000401:mortality; D011153:Population; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States; D014903:West Virginia / Q000453:epidemiology
D000319:Adrenergic beta-Antagonists