Mortality and Healthcare Resources Utilization following Acute Myocardial Infarction According to Adherence with Guideline Recommended Medical Therapy

Background: Guideline recommended medical therapy plays a pivotal role in improving long term outcomes and healthcare burden of AMI patients. Objectives: to evaluate adherence with medical therapy following AMI and the association with long-term mortality, healthcare resources utilization and costs.

Methods: Patients hospitalized in Soroka Medical Center with AMI throughout 2002-2012, survived at least a year following post-discharge and were insured by Clalit and Maccabi Health services were analyzed. Data were obtained from computerized medical records. Adherence patients we defined as those in which 80% or more issued prescriptions throughout the first year following hospital discharge for Aspirin, Statins, Beta-blockers and Angiotensin-converting-enzyme inhibitors / Angiotensin II receptor blockers. Hospitalizations, emergency department visits, primary care utilization and outpatient consulting clinic and other ambulatory services expenditure were calculated annually during the up-to-10 years follow-up.

Results: 8,287 qualified for the study (mean age 65.0±13.6 years, 69.7% males, 50.4% STEMI). Adherent patients (n=1767, 21.3%) were younger, higher percent of women, with increased prevalence of most cardiovascular risk factors, STEMI, yet lower rate of PCI administration. Throughout the follow-up 2,620 patients (31.6%) died, 22.0% and 34.2%, in the adherent and the non-adherent groups (adjHR=0.78, 95% CI:0.7-0.87, p<0.001). Reduced hospitalizations (adjOR=0.623, p<0.001) and costs (adjOR=0.775, p=0.028), yet increased ambulatory (mainly primary clinics) visits (adjOR=6.857, p<0.001) were observed (see figure).

Conclusions: adherence with guideline recommended medical therapy following AMI is associated with decreased mortality, hospitalizations and costs.

Figure. Healthcare resources utilization according to adherence with medical therapy: a) length of hospital stay, b) hospital emergency department visits (not resulted in hospital admission), c) primary clinic visits, d) ambulatory visits, e) consultant visits, f) total cost (United States Dollar - USD).