title: National evaluation of adherence to beta-blocker therapy for 1 year after acute myocardial infarction in patients with commercial health insurance.
abstract: 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.
authors.affiliation: Duke Center for Education and Research on Therapeutics, Duke University Medical Center, Durham, NC 27715, USA. judith.kramer@duke.edu
authors.forename: Judith M
authors.initials: JM
authors.lastname: Kramer
authors.forename: Bradley
authors.initials: B
authors.lastname: Hammill
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Anstrom
authors.forename: Donald
authors.initials: D
authors.lastname: Fetterolf
authors.forename: Richard
authors.initials: R
authors.lastname: Snyder
authors.forename: John P
authors.initials: JP
authors.lastname: Charde
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Hoffman
authors.forename: Nancy
authors.initials: N
authors.lastname: Allen LaPointe
authors.forename: Eric
authors.initials: E
authors.lastname: Peterson
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007348:Insurance, Health / Q000639:trends; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000453:epidemiology; D010349:Patient Compliance; D010351:Patient Discharge / Q000639:trends
chemical_list: D000319:Adrenergic beta-Antagonists