Premium
Effect of Exposure to Evidence‐Based Pharmacotherapy on Outcomes After Acute Myocardial Infarction in Older Adults
Author(s) -
Zuckerman Ilene H.,
Yin Xianghua,
Rattinger Gail B.,
Gottlieb Stephen S.,
SimoniWastila Linda,
Pierce Sarah A.,
Huang TingYing,
Shenolikar Rahul,
Stuart Bruce
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04165.x
Subject(s) - medicine , myocardial infarction , pharmacotherapy , intensive care medicine , medline , emergency medicine , political science , law
Objectives To assess the effect of exposure to evidence‐based medication after hospital discharge for M edicare beneficiaries with acute myocardial infarction ( AMI ). Design A discrete‐time hazard model was used to estimate time to outcome associated with exposure to four drug classes (angiotensin‐converting enzyme inhibitors ( ACEI s)/angiotensin‐II receptor blockers ( ARB s), beta‐blockers ( BB s), statins, and clopidogrel) used for post‐ AMI secondary prevention of cardiovascular events and mortality. Setting Medicare administrative data for a 5% random sample of beneficiaries. Participants Medicare beneficiaries (N = 9,538) hospitalized for an AMI between A pril 1, 2006, and D ecember 31, 2007, who survived for at least 30 days after discharge. The cohort was followed until death or D ecember 31, 2008. Measurements Time‐varying exposure was measured as proportion of days covered ( PDC ) for each quarter during the follow‐up period. PDC was classified into five categories (0–0.2, 0.2–0.4, 0.4–0.6, 0.6–0.8, 0.8–1.0). Outcomes were mortality and a composite outcome of death or post‐ AMI hospitalization. Results Over a median follow‐up of 18 months, mean PDC rates ranged from 0.37 (clopidogrel) to 0.50 (statins). When comparing the highest versus lowest categories of exposure, the hazard of the composite outcome was significantly lower for all drug classes except BB s (statins, adjusted hazard ratio (a HR ) = 0.71, ACEI s/ ARB s, a HR = 0.81, clopidogrel, a HR = 0.85, BBs, a HR = 0.93). All four drug classes were significantly associated with reductions in mortality; the magnitude of effect for the mortality outcome was largest for statins and smallest for BB s. Age modified the effect of statins on mortality. Conclusion Use of evidence‐based medications for secondary prevention after AMI is suboptimal in the M edicare population, and low exposure rates are associated with significantly higher risk for subsequent hospitalization and death.