title: Beta-blocker compliance, mortality, and reinfarction: validation of clinical trial association using insurer claims data.
abstract: Although randomized controlled trials show that long-term beta-blocker use post acute myocardial infarction (AMI) reduces mortality and subsequent cardiovascular events, and that increased compliance lowers mortality, there is limited published research on the effects of long-term beta-blocker compliance in observational community settings. The authors retrospectively study the effect of beta -blocker compliance on mortality and repeat reinfarction using claims records from a major health insurer of all patients who were discharged alive after AMI between January 2003 and June 2004, covered by that health insurer's prescription drug coverage, and prescribed beta-blockers (n = 3923). Using Cox proportional hazards regressions, they estimate both survival and AMI-free survival rates by compliance quartile. Both survival and AMI-free survival rates diverge rapidly and are robust to adjustments for demographics, DxCG risk score, and other baseline risk factors. Results suggest that patients whose post-AMI compliance with beta-blocker therapy is above average experience lower mortality and reinfarction. This is especially true for high-risk patients.
authors.affiliation: Carnegie Mellon University, Pittsburgh, Pennsylvania 15213, USA. skleiner@andrew.cmu.edu
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Kleiner
authors.forename: William B
authors.initials: WB
authors.lastname: Vogt
authors.forename: Patricia
authors.initials: P
authors.lastname: Gladowski
authors.forename: Andrea
authors.initials: A
authors.lastname: DeVries
authors.forename: Gary
authors.initials: G
authors.lastname: Levin
authors.forename: Christopher
authors.initials: C
authors.lastname: Antonucci
authors.forename: John
authors.initials: J
authors.lastname: Fong
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000368:Aged; D002986:Clinical Trials as Topic; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting / Q000706:statistics & numerical data*; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control*; D010349:Patient Compliance / Q000706:statistics & numerical data*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D055502:Secondary Prevention; D016019:Survival Analysis; D013997:Time Factors
chemical_list: D000319:Adrenergic beta-Antagonists