Butler Javed, Arbogast Patrick G, BeLue Rhonda, Daugherty James, Jain Manoj K, Ray Wayne A, Griffin Marie R
Department of Medicine, Cardiology Division, 383-PRB, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
J Am Coll Cardiol. 2002 Nov 6;40(9):1589-95. doi: 10.1016/s0735-1097(02)02379-3.
This study was designed to determine adherence to outpatient beta-blocker therapy following acute myocardial infarction (AMI).
The importance of beta-blocker therapy after AMI is widely recognized. Outpatient adherence with this recommendation, however, is not well described.
Data on 846 patients surviving AMI were studied. Factors associated with filling a beta-blocker prescription within 30 days postdischarge and the proportion of patients who were or were not discharged on beta-blockers who filled prescriptions for them by 30, 180, and 365 days post-AMI discharge were assessed.
Patients with a discharge order for beta-blocker therapy were more likely to fill a prescription in the first 30 days postdischarge (hazard ratio [HR] 15.82, 95% confidence interval [CI], 10.75 to 23.26). Patients older than age 75 years were less likely than those age <65 years to fill a prescription (HR 0.63, 95% CI 0.42 to 0.93). Gender, race, and being an ideal candidate did not affect beta-blocker use. Among patients who were discharged on beta-blockers, 85% of survivors had filled a prescription by 30 days postdischarge, and 63% and 61% were current users at 180 and 365 days, respectively. In contrast, only 8% of those patients with no discharge order for beta-blockers had filled such a prescription by 30 days, and 13% and 12% of patients were current users at 180 and 365 days, respectively.
Patients not discharged on beta-blockers are unlikely to be started on them as outpatients. For patients who are discharged on beta-blockers after AMI, there is a significant decline in use after discharge. Quality improvement efforts need to be focused on improving discharge planning and to continue these efforts after discharge.
本研究旨在确定急性心肌梗死（AMI）后门诊β受体阻滞剂治疗的依从性。
AMI后β受体阻滞剂治疗的重要性已得到广泛认可。然而，门诊对这一建议的依从性情况尚无详尽描述。
对846例AMI存活患者的数据进行研究。评估与出院后30天内开具β受体阻滞剂处方相关的因素，以及AMI出院后30天、180天和365天开具β受体阻滞剂处方的出院时服用或未服用β受体阻滞剂患者的比例。
出院时开具β受体阻滞剂治疗医嘱的患者在出院后前30天更有可能开具处方（风险比[HR]15.82，95%置信区间[CI]，10.75至23.26）。75岁及以上患者开具处方的可能性低于65岁以下患者（HR 0.63，95%CI 0.42至0.93）。性别、种族以及是否为理想候选对象均不影响β受体阻滞剂的使用。在出院时服用β受体阻滞剂的患者中，85%的存活者在出院后30天内开具了处方，在180天和365天时分别有63%和61%的患者仍在使用。相比之下，出院时未开具β受体阻滞剂医嘱的患者中，仅8%在30天内开具了此类处方，在180天和365天时分别有13%和12%的患者仍在使用。
出院时未服用β受体阻滞剂的患者作为门诊患者不太可能开始服用。对于AMI后出院时服用β受体阻滞剂的患者，出院后用药量显著下降。质量改进工作需要集中在改善出院计划并在出院后持续开展这些工作。
