Evaluating the effect on patient outcomes of appropriate and inappropriate use of beta-blockers as secondary prevention after myocardial infarction in a medicaid population
Abstract Acute myocardial infarction (AMI) is associated with high mortality in the United States. Beta-blockers have been shown to reduce mortality and reinfarction rates when used for long-term prevention after an AMI. However, this therapy is both underused and misused. The effect of this practic...
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| Veröffentlicht in: | Clinical therapeutics 2005-05, Vol.27 (5), p.630-645 |
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| creator | Fernandes, Ancilla W. Suresh Madhavan, S. Amonkar, Mayur M. |
| description | Abstract
Acute myocardial infarction (AMI) is associated with high mortality in the United States. Beta-blockers have been shown to reduce mortality and reinfarction rates when used for long-term prevention after an AMI. However, this therapy is both underused and misused. The effect of this practice on outcomes needs to be investigated.
This study was undertaken to evaluate the effect on patient outcomes (ie, fatality, health care utilization, and costs) of appropriate and inappropriate prescribing of beta-blocker therapy after AMI in a Medicaid population aged |
| doi_str_mv | 10.1016/j.clinthera.2005.04.013 |
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Acute myocardial infarction (AMI) is associated with high mortality in the United States. Beta-blockers have been shown to reduce mortality and reinfarction rates when used for long-term prevention after an AMI. However, this therapy is both underused and misused. The effect of this practice on outcomes needs to be investigated.
This study was undertaken to evaluate the effect on patient outcomes (ie, fatality, health care utilization, and costs) of appropriate and inappropriate prescribing of beta-blocker therapy after AMI in a Medicaid population aged <65 years.
Data for 1 year before and after AMI were extracted from West Virginia Medicaid claims from January 1, 1996, to June 30, 2001. Information was obtained regarding prescriptions for beta-blockers for these patients within 90 days after discharge. Patients were divided into 2 groups: those who were prescribed therapy appropriately and those who were prescribed therapy inappropriately (underuse or misuse). Fatality rates during 1 year after discharge were compared using chi-square analysis. The study used regression analysis to model health care utilization and costs as a function of appropriately/inappropriately prescribed groups.
Data were assessed for 488 eligible patients (mean [SD] age, 53.70 [8.14] years; 246 men [50.4%], 242 women [49.6%]). Overall, 309 patients (63.3%) had appropriate prescribing of beta-blockers; at the end of 1 year, these patients had a significantly lower all-cause death rate compared with those who were prescribed therapy inappropriately (P = 0.030). Although the cardiac death rate was slightly lower for the appropriate group, the difference was not statistically significant. The appropriately prescribed group had significantly higher health care utilization in the follow-up period (P < 0.050 for hospital visits, emergency department visits, and length of stay). These groups demonstrated differences in a few variables at baseline (age, presence of absolute contraindications, presence of hypertension, number of noncardiac admissions before AMI, and use of beta-blockers before AMI: all, P < 0.050), implying different severity levels. Patient health status at the time of the incident AMI had a confounding effect on health care utilization, and there were indications that the appropriate group had greater severity compared with the inappropriate group.
Appropriate prescribing of beta-blockers for secondary prevention after an AMI was associated with better survival in this population. However, the effects of inappropriate and appropriate beta-blocker prescribing on health care utilization need to be evaluated prospectively so that all severity indicators can be properly adjusted.</description><identifier>ISSN: 0149-2918</identifier><identifier>EISSN: 1879-114X</identifier><identifier>DOI: 10.1016/j.clinthera.2005.04.013</identifier><identifier>PMID: 15978313</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>ACC/AHA guidelines ; Adrenergic beta-Antagonists - therapeutic use ; Adult ; AMI ; Angioplasty ; Antihypertensive Agents - therapeutic use ; Asthma ; Beta blockers ; Cardiology ; Cardiovascular disease ; Diabetes ; Drug Utilization ; fatality ; Female ; Health Care Costs ; Health care policy ; Heart attacks ; Humans ; Hypertension ; inappropriate prescribing ; Male ; Medicaid ; Middle Aged ; Myocardial Infarction - economics ; Myocardial Infarction - mortality ; Myocardial Infarction - prevention & control ; Practice Patterns, Physicians' - statistics & numerical data ; secondary prevention ; Task forces ; Treatment Outcome ; utilization</subject><ispartof>Clinical therapeutics, 2005-05, Vol.27 (5), p.630-645</ispartof><rights>2005 Excerpta Medica, Inc. All rights reserved</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c397t-3f6273dad699a4de90303adf94066f5fa2d134a7ed3f891c062b8e5605e0d003</citedby><cites>FETCH-LOGICAL-c397t-3f6273dad699a4de90303adf94066f5fa2d134a7ed3f891c062b8e5605e0d003</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0149291805000767$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/15978313$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fernandes, Ancilla W.</creatorcontrib><creatorcontrib>Suresh Madhavan, S.</creatorcontrib><creatorcontrib>Amonkar, Mayur M.</creatorcontrib><title>Evaluating the effect on patient outcomes of appropriate and inappropriate use of beta-blockers as secondary prevention after myocardial infarction in a medicaid population</title><title>Clinical therapeutics</title><addtitle>Clin Ther</addtitle><description>Abstract
Acute myocardial infarction (AMI) is associated with high mortality in the United States. Beta-blockers have been shown to reduce mortality and reinfarction rates when used for long-term prevention after an AMI. However, this therapy is both underused and misused. The effect of this practice on outcomes needs to be investigated.
This study was undertaken to evaluate the effect on patient outcomes (ie, fatality, health care utilization, and costs) of appropriate and inappropriate prescribing of beta-blocker therapy after AMI in a Medicaid population aged <65 years.
Data for 1 year before and after AMI were extracted from West Virginia Medicaid claims from January 1, 1996, to June 30, 2001. Information was obtained regarding prescriptions for beta-blockers for these patients within 90 days after discharge. Patients were divided into 2 groups: those who were prescribed therapy appropriately and those who were prescribed therapy inappropriately (underuse or misuse). Fatality rates during 1 year after discharge were compared using chi-square analysis. The study used regression analysis to model health care utilization and costs as a function of appropriately/inappropriately prescribed groups.
Data were assessed for 488 eligible patients (mean [SD] age, 53.70 [8.14] years; 246 men [50.4%], 242 women [49.6%]). Overall, 309 patients (63.3%) had appropriate prescribing of beta-blockers; at the end of 1 year, these patients had a significantly lower all-cause death rate compared with those who were prescribed therapy inappropriately (P = 0.030). Although the cardiac death rate was slightly lower for the appropriate group, the difference was not statistically significant. The appropriately prescribed group had significantly higher health care utilization in the follow-up period (P < 0.050 for hospital visits, emergency department visits, and length of stay). These groups demonstrated differences in a few variables at baseline (age, presence of absolute contraindications, presence of hypertension, number of noncardiac admissions before AMI, and use of beta-blockers before AMI: all, P < 0.050), implying different severity levels. Patient health status at the time of the incident AMI had a confounding effect on health care utilization, and there were indications that the appropriate group had greater severity compared with the inappropriate group.
Appropriate prescribing of beta-blockers for secondary prevention after an AMI was associated with better survival in this population. However, the effects of inappropriate and appropriate beta-blocker prescribing on health care utilization need to be evaluated prospectively so that all severity indicators can be properly adjusted.</description><subject>ACC/AHA guidelines</subject><subject>Adrenergic beta-Antagonists - therapeutic use</subject><subject>Adult</subject><subject>AMI</subject><subject>Angioplasty</subject><subject>Antihypertensive Agents - therapeutic use</subject><subject>Asthma</subject><subject>Beta blockers</subject><subject>Cardiology</subject><subject>Cardiovascular disease</subject><subject>Diabetes</subject><subject>Drug Utilization</subject><subject>fatality</subject><subject>Female</subject><subject>Health Care Costs</subject><subject>Health care policy</subject><subject>Heart attacks</subject><subject>Humans</subject><subject>Hypertension</subject><subject>inappropriate prescribing</subject><subject>Male</subject><subject>Medicaid</subject><subject>Middle Aged</subject><subject>Myocardial Infarction - economics</subject><subject>Myocardial Infarction - mortality</subject><subject>Myocardial Infarction - prevention & control</subject><subject>Practice Patterns, Physicians' - statistics & numerical data</subject><subject>secondary prevention</subject><subject>Task forces</subject><subject>Treatment Outcome</subject><subject>utilization</subject><issn>0149-2918</issn><issn>1879-114X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2005</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>BENPR</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkc1u1DAURi0EotPCK4AlJHYJdpw_L6uqUKRK3XTRnXXHvgYPSRzsZKS-Ew_Jnc4IEJuubPkef06-w9h7KUopZPtpV9ohTMt3TFBWQjSlqEsh1Qu2kX2nCynrh5dsI2Sti0rL_oyd57wTQijdVK_ZmWx01yupNuzX9R6GFZYwfeMUx9F7tAuPE5_pECfarouNI2YePYd5TnFOARbkMDkepn9P1owHaIsLFNsh2h-YMofMM9o4OUiPfE64p8xA8eAXTHx8jBaSCzBQlodkn2aBxnxEFywEx-c4rwMcBm_YKw9Dxren9YLdf76-v7opbu--fL26vC2s0t1SKN9WnXLgWq2hdqiFEgqc17VoW994qJxUNXTolO-1tKKttj02rWhQOOrogn08xtKv_VwxL2YM2eIwwIRxzabtdCd7rQn88B-4i2ua6NOMFKrSZKatiOqOlE0x54TeUF8j1UGQOdg0O_PHpjnYNKI2ZJNuvjvlr1uq4--9kz4CLo8AUhv7gMlkS9IsVZdIo3ExPPvIb6cYuYM</recordid><startdate>200505</startdate><enddate>200505</enddate><creator>Fernandes, Ancilla W.</creator><creator>Suresh Madhavan, S.</creator><creator>Amonkar, Mayur M.</creator><general>Elsevier Inc</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>M2O</scope><scope>M7N</scope><scope>MBDVC</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>200505</creationdate><title>Evaluating the effect on patient outcomes of appropriate and inappropriate use of beta-blockers as secondary prevention after myocardial infarction in a medicaid population</title><author>Fernandes, Ancilla W. ; Suresh Madhavan, S. ; Amonkar, Mayur M.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c397t-3f6273dad699a4de90303adf94066f5fa2d134a7ed3f891c062b8e5605e0d003</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2005</creationdate><topic>ACC/AHA guidelines</topic><topic>Adrenergic beta-Antagonists - therapeutic use</topic><topic>Adult</topic><topic>AMI</topic><topic>Angioplasty</topic><topic>Antihypertensive Agents - therapeutic use</topic><topic>Asthma</topic><topic>Beta blockers</topic><topic>Cardiology</topic><topic>Cardiovascular disease</topic><topic>Diabetes</topic><topic>Drug Utilization</topic><topic>fatality</topic><topic>Female</topic><topic>Health Care Costs</topic><topic>Health care policy</topic><topic>Heart attacks</topic><topic>Humans</topic><topic>Hypertension</topic><topic>inappropriate prescribing</topic><topic>Male</topic><topic>Medicaid</topic><topic>Middle Aged</topic><topic>Myocardial Infarction - economics</topic><topic>Myocardial Infarction - mortality</topic><topic>Myocardial Infarction - prevention & control</topic><topic>Practice Patterns, Physicians' - statistics & numerical data</topic><topic>secondary prevention</topic><topic>Task forces</topic><topic>Treatment Outcome</topic><topic>utilization</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fernandes, Ancilla W.</creatorcontrib><creatorcontrib>Suresh Madhavan, S.</creatorcontrib><creatorcontrib>Amonkar, Mayur M.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Research Library (Alumni Edition)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>Research Library Prep</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Research Library</collection><collection>Algology Mycology and Protozoology Abstracts (Microbiology C)</collection><collection>Research Library (Corporate)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><jtitle>Clinical therapeutics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fernandes, Ancilla W.</au><au>Suresh Madhavan, S.</au><au>Amonkar, Mayur M.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluating the effect on patient outcomes of appropriate and inappropriate use of beta-blockers as secondary prevention after myocardial infarction in a medicaid population</atitle><jtitle>Clinical therapeutics</jtitle><addtitle>Clin Ther</addtitle><date>2005-05</date><risdate>2005</risdate><volume>27</volume><issue>5</issue><spage>630</spage><epage>645</epage><pages>630-645</pages><issn>0149-2918</issn><eissn>1879-114X</eissn><abstract>Abstract
Acute myocardial infarction (AMI) is associated with high mortality in the United States. Beta-blockers have been shown to reduce mortality and reinfarction rates when used for long-term prevention after an AMI. However, this therapy is both underused and misused. The effect of this practice on outcomes needs to be investigated.
This study was undertaken to evaluate the effect on patient outcomes (ie, fatality, health care utilization, and costs) of appropriate and inappropriate prescribing of beta-blocker therapy after AMI in a Medicaid population aged <65 years.
Data for 1 year before and after AMI were extracted from West Virginia Medicaid claims from January 1, 1996, to June 30, 2001. Information was obtained regarding prescriptions for beta-blockers for these patients within 90 days after discharge. Patients were divided into 2 groups: those who were prescribed therapy appropriately and those who were prescribed therapy inappropriately (underuse or misuse). Fatality rates during 1 year after discharge were compared using chi-square analysis. The study used regression analysis to model health care utilization and costs as a function of appropriately/inappropriately prescribed groups.
Data were assessed for 488 eligible patients (mean [SD] age, 53.70 [8.14] years; 246 men [50.4%], 242 women [49.6%]). Overall, 309 patients (63.3%) had appropriate prescribing of beta-blockers; at the end of 1 year, these patients had a significantly lower all-cause death rate compared with those who were prescribed therapy inappropriately (P = 0.030). Although the cardiac death rate was slightly lower for the appropriate group, the difference was not statistically significant. The appropriately prescribed group had significantly higher health care utilization in the follow-up period (P < 0.050 for hospital visits, emergency department visits, and length of stay). These groups demonstrated differences in a few variables at baseline (age, presence of absolute contraindications, presence of hypertension, number of noncardiac admissions before AMI, and use of beta-blockers before AMI: all, P < 0.050), implying different severity levels. Patient health status at the time of the incident AMI had a confounding effect on health care utilization, and there were indications that the appropriate group had greater severity compared with the inappropriate group.
Appropriate prescribing of beta-blockers for secondary prevention after an AMI was associated with better survival in this population. However, the effects of inappropriate and appropriate beta-blocker prescribing on health care utilization need to be evaluated prospectively so that all severity indicators can be properly adjusted.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>15978313</pmid><doi>10.1016/j.clinthera.2005.04.013</doi><tpages>16</tpages></addata></record> |
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| ispartof | Clinical therapeutics, 2005-05, Vol.27 (5), p.630-645 |
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| subjects | ACC/AHA guidelines Adrenergic beta-Antagonists - therapeutic use Adult AMI Angioplasty Antihypertensive Agents - therapeutic use Asthma Beta blockers Cardiology Cardiovascular disease Diabetes Drug Utilization fatality Female Health Care Costs Health care policy Heart attacks Humans Hypertension inappropriate prescribing Male Medicaid Middle Aged Myocardial Infarction - economics Myocardial Infarction - mortality Myocardial Infarction - prevention & control Practice Patterns, Physicians' - statistics & numerical data secondary prevention Task forces Treatment Outcome utilization |
| title | Evaluating the effect on patient outcomes of appropriate and inappropriate use of beta-blockers as secondary prevention after myocardial infarction in a medicaid population |
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