Myocardial infarction is classified as the death of a segment of the heart due to lack of blood supply. National statistics indicate there will be an estimated 700,000 Americans that suffer a myocardial infarction or other type of cardiac attack this year.¹ According to data collected by the National Center for Health Statistics, over the five-year period from 1999 through 2004, an estimated 7.9 million patients had an acute myocardial infarction (AMI).² The American Heart Association and American College of Cardiology both have guidelines for treatment after an AMI that recommend beta-blockers during the hospital stay and upon discharge for those patients who do not have contraindications to beta-blocker use. Beta-blockers decrease myocardial oxygen demand along with slowing heart rate and lowering blood pressure.

A retrospective study of Medi-Cal Fee-for-Service (FFS) recipients was conducted to measure the extent of compliance with treatment with beta-blocker medications after discharge from hospital after a heart attack. The study of Medi-Cal FFS recipients followed the study design prepared by the National Committee for Quality Assurance (NCQA) for HEDIS 2008.³ The study, “Persistence of Beta-Blocker Treatment After a Heart Attack,” outlines the specific diagnosis codes used to identify acute myocardial infarction (AMI) along with the diagnosis codes to use for excluding patients where beta-blocker therapy would be contraindicated. Though the HEDIS study covered a 12-month period, Medi-Cal used a 9-month period to find those patients who had a heart attack, with an additional 6 months to track prescriptions for beta-blockers after their heart attack.

• 576 Medi-Cal FFS recipients met the criteria outlined in the HEDIS 2008 study for inclusion in this study.
  • Though 80% filled a prescription for beta-blocker medications within 180 days of their discharge from a hospital after suffering an AMI, only 32% met the HEDIS criteria for continuing treatment for 6 months following their heart attack
  • Over 53% of patients filled a prescription for beta-blocker medications within 30 days of discharge from hospital

See:  Patient Compliance with Beta-Blocker Prescriptions After Heart Attack chart

The Medi-Cal data shows that about one-half of patients are filling an initial prescription for beta-blocker after an AMI, but the long term, continuing treatment for their condition is not occurring. Because compliance is often an issue, physicians should be talking to their patients about the importance of taking medications as prescribed at every appointment. Pharmacists can also help monitor that patients are getting their beta-blockers refilled at appropriate time intervals and by asking patients how they are coping with any side effects that may be occurring due to the medication. This can occur when other prescriptions are picked up and possibly through mailed notices or phone reminders that their prescriptions needs to be refilled.

Medi-Cal recommends prescribers and other health professionals follow the most current recommendations by the American Heart Association and American College of Cardiology for treatment after a myocardial infarction. The most current recommendations can be found at: www.americanheart.org/presenter.jhtml?identifier=3003999

References

1. AHA/ASA Heart Disease and Stroke Statistics 2007 Update.


2. Rosamond, et al. Heart Disease and Stroke Statistics – 2007 Update: A report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2007; 115; 69-171.
   
3. National Committee for Quality Assurance (NCQA). Persistence of Beta-Blocker Treatment After a Heart Attack. HEDIS 2008, Volume 2 Technical Specifications.