MedWire News: Patients are more likely to adhere to recommended medications after an acute myocardial infarction (AMI) if they see a doctor within a month of leaving hospital, research suggests.
The study by Stacie Daugherty (University of Colorado Denver Health Sciences Center, USA) and team also suggests post-AMI patients' adherence to discharge medications is improved if they receive collaborative follow-up from both a primary care provider (PCP) and a cardiologist.
The researchers explain in the Archives of Internal Medicine that there is currently limited evidence to support guidelines recommending that patients with AMI receive follow-up within several weeks of discharge.
They say their results "suggest that outpatient follow-up, including collaborative follow-up within the first weeks after AMI, may result in higher-quality patient care."
The team studied 1516 patients hospitalized with AMI enrolled in the multicenter Prospective Registry Evaluating Outcomes after MI: Events and Recovery Registry who completed follow-up interviews at 1 month and 6 months.
Of these patients, 34% did not receive early follow-up, defined as patient-reported visits with a primary care physician or cardiologist within 1 month of discharge.
Meanwhile, 52% had early follow-up with only a PCP or cardiologist and 14% had collaborative early follow-up with both a PCP and a cardiologist.
Appropriate discharge prescription rates were similar irrespective of follow-up status or follow-up provider specialty. Patients with any early follow-up were more likely than those with no early follow-up to be prescribed beta blockers (80.9% vs 71.3%), aspirin (82.9% vs 77.7%), or statins (75.9% vs 68.6%) at 6 months.
Multivariable analysis indicated that patients with early follow-up had higher rates of beta blocker use (relative risk [RR]=1.08), with a trend toward increased aspirin use (RR=1.05).
And multivariable analysis according to provider specialty showed that patients who received collaborative early follow-up had higher rates of statin use than those who received follow-up from a PCP or cardiologist alone (RR=1.11, p=0.02).
The researchers conclude: "Although further prospective studies should determine whether the relationship between follow-up and medication use is causal, and whether differences in medication use result in improved long-term outcomes, these results support current guideline recommendations for prompt outpatient care after AMI and suggest a structure for this follow-up."
Elizabeth Jackson (University of Michigan, Ann Arbor, USA) commented on Daugherty and co-workers' research in a related article. She wrote: "Based on their results, a clear benefit to early follow-up from both a primary care physician and a cardiologist resulted in improvements in use of guideline-recommended therapies at 6 months.
"Further research on outpatient care is warranted, including additional information on patient-related factors that may affect adherence to evidence-based medications. The development of system-based tools that health care providers can implement to improve outpatient cardiac secondary prevention efforts will likely result in reduction of recurrent cardiac events."
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