Outpatient adherence to beta-blocker therapy after acute myocardial infarction

J Am Coll Cardiol. 2002 Nov 6;40(9):1589-95. doi: 10.1016/s0735-1097(02)02379-3.


Objectives: This study was designed to determine adherence to outpatient beta-blocker therapy following acute myocardial infarction (AMI).

Background: The importance of beta-blocker therapy after AMI is widely recognized. Outpatient adherence with this recommendation, however, is not well described.

Methods: Data on 846 patients surviving AMI were studied. Factors associated with filling a beta-blocker prescription within 30 days postdischarge and the proportion of patients who were or were not discharged on beta-blockers who filled prescriptions for them by 30, 180, and 365 days post-AMI discharge were assessed.

Results: Patients with a discharge order for beta-blocker therapy were more likely to fill a prescription in the first 30 days postdischarge (hazard ratio [HR] 15.82, 95% confidence interval [CI], 10.75 to 23.26). Patients older than age 75 years were less likely than those age <65 years to fill a prescription (HR 0.63, 95% CI 0.42 to 0.93). Gender, race, and being an ideal candidate did not affect beta-blocker use. Among patients who were discharged on beta-blockers, 85% of survivors had filled a prescription by 30 days postdischarge, and 63% and 61% were current users at 180 and 365 days, respectively. In contrast, only 8% of those patients with no discharge order for beta-blockers had filled such a prescription by 30 days, and 13% and 12% of patients were current users at 180 and 365 days, respectively.

Conclusions: Patients not discharged on beta-blockers are unlikely to be started on them as outpatients. For patients who are discharged on beta-blockers after AMI, there is a significant decline in use after discharge. Quality improvement efforts need to be focused on improving discharge planning and to continue these efforts after discharge.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use*
  • Aged
  • Aged, 80 and over
  • Ambulatory Care
  • Cohort Studies
  • Drug Utilization Review*
  • Female
  • Humans
  • Male
  • Medicare
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • Patient Compliance / statistics & numerical data*
  • Patient Discharge
  • Tennessee


  • Adrenergic beta-Antagonists