Saturday, December 06, 2014

Persistent use of evidence based cardiac medications following hospital discharge

From registry data:

 We linked Medicare pharmacy claims data with 3,184 patients with non–ST-segment elevation MI greater than 65 years of age who were treated in 2006 at 253 hospitals participating in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology and American Heart Association guidelines registry. Using multivariate regression, we compared persistent filling of β blockers, angiotensin-converting enzyme inhibitors and/or angiotensin receptor blockers, clopidogrel, and statins at 90 days and 1 year postdischarge between patients discharged from academic and nonacademic hospitals...Composite persistence to all EBMs prescribed at discharge was low and not significantly different between academic and nonacademic hospitals at 90 days (46% vs 45%, adjusted incidence rate ratio = 0.99, 95% confidence interval 0.95 to 1.04) and at 1 year (39% vs 39%, adjusted incidence rate ratio = 1.02, 95% confidence interval 0.98 to 1.07). 

This helps to further explain why core measure performance incentives do not work. Previous studies showed that performance driven evidence based medications prescribed at discharge are seldom titrated to goal in the clinic. This study takes it further and suggests that often they are not even continued at all.

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