Early outpatient follow-up after acute myocardial infarction was associated with a higher likelihood of beta-blocker use at 6 months (RR 1.08; 95% CI 1.02-1.15).
Cohort (n=1,516)
Yes
Does early outpatient follow-up improve the use of evidence-based medications at 6 months in patients hospitalized with acute myocardial infarction?
Early outpatient follow-up within 1 month after AMI discharge is associated with higher rates of evidence-based medication use at 6 months.
Relative Risk: 1.08 (95% CI 1.02–1.15)
Absolute Event Rate: 80.1% vs 71.3%
p-value: p=.001
BACKGROUND: Early outpatient follow-up after acute myocardial infarction (AMI) is recommended in guidelines, but its relationship with the use of evidence-based therapies is unknown. METHODS: We evaluated 1516 patients hospitalized with AMI from the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient- reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, beta-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider vs those receiving follow-up from both provider types. RESULTS: Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed beta-blockers (80.1% vs 71.3%; P = .001), aspirin (82.9% vs 77.1%; P = .01), or statins (75.9% vs 68.6%; P = .005) at 6 months. In multivariable analyses, a persistent relationship remained between early follow-up and beta-blocker use (risk ratio, 1.08; 95% confidence interval, 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (risk ratio, 1.11; 95% confidence interval, 1.01-1.22). CONCLUSIONS: Early outpatient follow-up and collaborative follow-up after AMI is associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.
Stacie L. Daugherty (2008) conducted a cohort in Acute myocardial infarction (n=1,516). Early outpatient follow-up vs. No early outpatient follow-up was evaluated on Use of beta-blockers at 6 months (RR 1.08, 95% CI 1.02-1.15, p=.001). Early outpatient follow-up after acute myocardial infarction was associated with a higher likelihood of beta-blocker use at 6 months (RR 1.08; 95% CI 1.02-1.15).