March 24, 2016 – A study of more than 20,000 heart attack patients found that delaying followup reduces the chances of medication adherence.
Medication adherence among older acute heart attack patients is low, but can be improved with outpatient care transitions immediately following hospital discharge. Delaying those care transitions, however, reduces the chances of medication adherence.
In a recent study published online this week in JAMA Cardiology, the DCRI’s Eric D. Peterson, MD, MPH; Lisa A. McCoy, MS; Laine Thomas, PhD; Tracy Y. Wang, MD, MHS, MSc (pictured); and colleagues from other institutions sought determine whether earlier outpatient follow-up after acute heart attack is associated with higher rates of medication adherence.
They analyzed data from 20,976 Medicare patients older than 65 years discharged from 461 hospitals in the United States after an acute heart attack between 2007 and 2010. The patients were grouped based on the timing of their first follow-up clinic visit: within one week, one to two weeks, two to six weeks, or more than six weeks after hospital discharge.
The researchers found that the median time to the first outpatient follow-up visit after hospital discharge was 14 days. Overall, the first follow-up clinic visit occurred one week or less after discharge in 5,542 patients (26.4 percent), one to two weeks in 5,246 patients (25 percent), two to six weeks in 6,830 patients (32.6 percent), and more than six weeks in 3,358 patients (16 percent). Rates of medication adherence ranged from 63.4 percent to 68.7 percent at 90 days and 54.4 percent to 63.5 percent at one year.
Compared with patients with follow-up visits within one week, those with follow-up in one to two weeks and two to six weeks had no significant difference in medication adherence; however, patients with follow-up more than six weeks after discharge had lower adherence at both 90 days and one year. Patients who underwent follow-up more than six weeks after discharge were more likely to live in low-income communities. However, their clinical characteristics were similar to those of patients who underwent earlier follow-up. After adjusting for these differences, delayed follow-up of more than six weeks remained associated with lower medication adherence at 90 days and one year compared with follow-up of six weeks or less.
These findings, the researchers concluded demonstrate that it is possible to improve medication adherence with outpatient interventions, if they occur immediately after hospital discharge.