Kim Eagle , MD , and the editors of ACC . org , present relevant articles taken from various journals .
CLINICAL
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JOURNAL WRAP
Kim Eagle , MD , and the editors of ACC . org , present relevant articles taken from various journals .
Earlier Follow-up Improves Medication Adherence
In older patients with acute myocardial infarction ( AMI ), long-term adherence to medication for secondary risk prevention is low , according to a recent study published in JAMA : Cardiology . However , patients who attend their first follow-up appointment within the first 6 weeks after discharge have much higher adherence rates , suggesting opportunities to improved adherence rates .
Kamil F . Faridi , MD , and colleagues analyzed 20,976 Medicare patients who were over 65 years of age and who had been discharged alive after an AMI between 2007 and 2010 , from hospitals participating in the Acute Coronary Treatment and Intervention Outcomes Network Registry – Get With the Guidelines ( ACTION ® Registry-GWTG™ ). The first outpatient clinic visit was defined as the first appointment after hospital discharge with a cardiology , primary care , internal medicine , or family practice health care professional . Patients were grouped based on the timing of first follow-up clinical visit within 1 week , 1-2 weeks , 2-6 weeks , or > 6 weeks after hospital discharge . Primary outcomes of interest were medication adherence at 90 days and 1 year from discharge . Medication adherence was defined using Medicare Part D prescription fill data as the proportion of days
The data show that adherence to evidence-based therapies among patients after AMI remains low and suggest that greater focus on medication adherence is needed to improve patient outcomes . covered of ≥ 80 % for each medication .
The median time to the first outpatient follow-up visit after hospital discharge was 14 days ( interquartile range , 7-28 days ). Among the 20,332 first follow-up visits , 9,693 ( 47.7 %) were with a cardiologist . Rates of medication adherence for secondary prevention therapies ranged from 63.4 % to 68.7 % at 90 days , and 54.4 % to 63.5 % at 1 year . Compared with patients with follow-up visits within 1 week , those with follow-up in 1-2 weeks and 2-6 weeks had no significant difference in medication adherence ; however , patients with follow-up > 6 weeks after discharge had lower adherence at both 90 days ( 56.8 % -61.3 % vs . 64.7 % -69.3 %; p < 0.001 ) and 1 year ( 49.5 % -57.7 % vs . 55.4 % -64.1 %; p < 0.001 ). In adjusted analyses , delayed follow-up (> 6 weeks ) was associated with lower medication adherence at 90 days ( odds ratio [ OR ], 0.74 ; 95 % confidence interval [ CI ], 0.70-0.78 ) and 1 year ( OR , 0.79 ; 95 % CI , 0.73-0.85 ) compared with follow-up of ≤ 6 weeks .
The authors acknowledge that socioeconomic differences were reported between patients with follow-up 6 weeks after hospital discharge and those with earlier follow-up . Those with follow-up more than 6 weeks after hospital discharge resided in lower socioeconomic communities . Patients with later followup time were also more likely to have been transferred from another hospital . The authors suggest that increased attention should be given to these patients before and after hospital discharge .
Meanwhile , patients with follow-up more than 6 weeks after discharge had no significant difference in adherence when their first visit was with a cardiologist , suggesting that patients who see a cardiologist may be more motivated to take their medication .
Significant efforts have been made in recent years to improve the quality of care of patients with AMI . The ACC and the American Heart Association have developed performance measures and quality improvement programs to measure and promote the utilization of evidence-based treatments . As a result , the authors noted that adherence to evidence-based therapies during hospital admission is near perfect , and attention has moved to post-discharge secondary prevention . Medication nonadherence in AMI patients is associated with adverse clinical outcomes and increased health care costs .
“ The data show that adherence to evidence-based therapies among patients after AMI remains low and suggest that greater focus on medication adherence is needed to improve patient outcomes ,” the authors write . They suggest that scheduling follow-up within 6 weeks of hospital discharge , especially with a cardiologist , may help improve medication adherence . Other potential strategies include patient involvement with transitions of care , discharge contracts , inclusion of inpatient and outpatient care , and care that involves primary care physicians and cardiologists .
Note : Check out ACC ’ s Hospital to Home Initiative for tools and best practices for reducing hospital readmissions . Learn more at CVQuality . ACC . org / H2H .
Faridi KF , Peterson ED , McCoy LA , et al . JAMA Cardiol . 2016 ; doi : 10.1001 / jamacardio . 2016.0001 .
Biomarker-based ABC-bleeding Risk Score for AF
A novel risk score for predicting major bleeding has been found to be better than existing risk scores for bleeding in patients with atrial fibrillation ( AF ), according to a paper
ACC . org / CSWN CardioSource WorldNews
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