Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1007 — Long Term Use of Beta Blockers in White and Black Patients after Acute Myocardial Infarction

Barnett MJ (Iowa City, VAMC (CRIISP)) , Vaughn-Sarazin MS (Iowa City, VAMC (CRIISP)), Rosenthal GE (Iowa City, VAMC (CRIISP))

Objectives:
While quality improvement efforts have focused on increasing the use of beta blockers in hospitalized patients with acute myocardial infarction (AMI), less is known about longer term use post discharge. The objectives of this study were to determine: 1) changes in the use of beta blockers over time; and 2) differences in long term use in black and white patients.

Methods:
The VA Patient Treatment File (PTF) was used to identify 1038 consecutive white (n=895) and black (n=143) patients admitted with a principle diagnosis of AMI in FY 2002 in VISNs 10, 15, & 23 and who were discharged alive. DSS pharmacy files were used to identify all outpatient prescriptions for beta-blockers during the 720 days after hospital discharge. Patients were considered to have “consistent beta-blocker use” during consecutive 180-day follow-up intervals if they received prescriptions for a 90 day or greater supply during the interval. Analyses within each interval only included patients who survived to the end of the interval.

Results:
Beta blockers were consistently used in 73.6% of patients during the first 180 day interval after discharge. Consistent use was relatively well maintained at 360, 540, and 720 days with rates of 70.5%, 68.6%, and 67.1%, respectively. Rates of consistent beta blocker use during the first 180 day interval were similar for blacks and whites (69.7% vs. 74.1%, P=.31), but were lower for blacks between 180-360 days (60.2% vs. 72.1%, P=.01), 360-540 days (58.7% vs. 70.1%; P=.02), and 540-720 days (54.6% vs. 69.1%; P<.01).

Implications:
Beta-blockers were consistently prescribed for nearly three-quarters of patients during the first 180 days after hospitalization for AMI. While use was similar in black and white patients during the first 180 days after discharge, rates of use were consistently lower in blacks thereafter. Such variation may be responsible, in part, for the differential long-term death rates between blacks and whites after AMI observed in other studies.

Impacts:
While recent interventions have been successful in increasing the use of beta blockers immediately after discharge, new efforts may be needed to identify and overcome barriers to long-term use in black patients.