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Heart attack patients who are not discharged from the hospital on beta-blockers are unlikely to be started on them as outpatients. Even patients who are discharged on beta-blockers following heart attack reduce use of these medications after discharge. Research has shown that heart attack patients not taking beta blockers are at higher risk of hospital readmission and death than those taking the medications. Clearly, improved discharge planning and followup of these patients after discharge are needed, concludes Wayne A. Ray, Ph.D., of the Centers for Education and Research on Therapeutics at Vanderbilt University.
In a study that was supported in part by the Agency for Healthcare Research and Quality (HS10384), Dr. Ray and his colleagues examined Medicaid data on beta-blocker prescriptions filled by 846 Medicaid-insured heart attack patients discharged from Tennessee hospitals. They studied patients who were and were not discharged on beta-blockers and determined the proportion who filled prescriptions for beta-blockers by 30, 180, and 365 days after hospital discharge. Patients with a discharge order for beta-blocker therapy were nearly 16 times more likely to fill a prescription in the first 30 days after hospital discharge than patients discharged without a prescription.
Among patients who were discharged on beta-blockers, 85 percent of survivors had filled prescriptions by 30 days postdischarge, and 63 percent and 61 percent were current users at 180 and 365 days after discharge, respectively. In contrast, only 8 percent of patients with no discharge order for beta-blockers had filled such a prescription by 30 days, and 13 percent and 12 percent of patients were current users at 180 and 365 days after discharge, respectively. Patients older than age 75 years were 37 percent less likely than those younger than 65 years to fill a prescription. Race, sex, and being an ideal candidate for the medication did not affect beta-blocker use.
See "Outpatient adherence to beta-blocker therapy after acute myocardial infarction," by Javed Butler, M.D., M.P.H., F.A.C.C., Patrick G. Arbogast, Ph.D., Rhonda BeLue, Ph.D., and others, in the November 6, 2002, Journal of the American College of Cardiology 40(9), pp. 1589-1595.
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