From JAMA Cardiology, “Timing of First Postdischarge Follow-up and Medication Adherence After Acute Myocardial Infarction“:
Importance The use of evidence-based medication therapy in patients after acute myocardial infarction (AMI) improves long-term prognosis, yet the current rates of adherence are poor.
Objective To determine whether earlier outpatient follow-up after AMI is associated with higher rates of medication adherence.
Design, Setting, and Participants A retrospective analysis was conducted of 20 976 Medicare patients older than 65 years discharged alive after an AMI between January 2, 2007, and October 1, 2010, from 461 Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines hospitals in the United States. Patients were grouped based on the timing of first follow-up clinic visit within 1 week, 1 to 2 weeks, 2 to 6 weeks, or more than 6 weeks after hospital discharge. Data analysis was conducted from September 26, 2014, to April 22, 2015.
Main Outcomes and Measures Medication adherence was defined as the proportion of days with more than 80% coverage using Medicare Part D prescription fill records and was examined at 90 days and 1 year after discharge for β-blockers, platelet P2Y12 receptor inhibitors, statins, and angiotensin-converting enzyme inhibitors or angiotensin receptor blockers.
Researchers looked back at almost 21,000 Medicare patients who survived a hospitalization after an acute myocardial infarction. They grouped patients by whether they had a first follow-up visit within a week, within 1-2 weeks, 2-6 weeks, or more than 6 weeks after going home. They then measured medication adherence to a variety of cardiac meds prescribed after the MI.
The median time to first follow-up visit was 14 days. Patients who were followed up in the first 6 weeks (groups 1, 2, and 3) had about the same level of adherence. But those with a first follow-up appointment had significantly lower adherence at 90 days (57%-61% versus 65%-59%) and at 1 year (50%-58% versus 55%-64%).
This isn’t just a causal thing, of course. Patients who don’t get follow-up until at least six weeks also live in communities that are poorer, and they have lower educational levels. But their clinical symptoms and characteristics don’t differ. But even after adjusting for these differences, those with longer times to follow-up had lower levels of adherence. This isn’t good. It seems reasonable to try and see them sooner. I can’t see how it would hurt, and it might help.
But, as always, access is more than just having insurance. Remember, all these people are on Medicare.