Early Drug Non-Adherence After Acute Myocardial Infarction

by PWeekly | Oct 21, 2016

Mortality rates associated with heart disease have declined in recent years throughout the United States in large part because of evidence-based therapies that help reduce risks of recurrent cardiovascular adverse events. When patients suffer an initial myocardial infarction (MI) and are treated in the hospital, they are prescribed evidence-based cardiovascular therapies. However, simply writing a prescription does not necessarily translate into downstream adherence after they leave the hospital. Previous research has shown that patient adherence to prescribed therapies is suboptimal with some reports estimating that more than 25% of patients do not fill their prescriptions within a week of being discharged after an acute MI. “Medication non-adherence after MI is a widely recognized problem in healthcare and has been linked to worse patient outcomes and higher healthcare costs,” says Robin Mathews, MD. “A better understanding of the modifiable factors that contribute to non-adherence may help us develop interventions to help optimize patient outcomes.” Longitudinal Observations In a study published in Circulation: Cardiovascular Quality & Outcomes, Dr. Mathews and colleagues assessed medication adherence among 7,425 acute MI patients who were treated with PCI at 216 U.S. hospitals over a period of 2 years. The institutions involved in the study participated in TReatment with ADP receptor iNhibitorS: Longitudinal Assessment of Treatment Patterns and Events after Acute Coronary Syndrome (TRANSLATE-ACS), a longitudinal observational study of PCI-treated MI. “There are many reasons why medication adherence is poor among cardiac patients,” Dr. Mathews says. “TRANSLATE-ACS is unique in that it allows us to evaluate both patient and provider factors that may contribute to non-adherence.” TRANSLATE-ACS provides data that can be used to determine...

Defibrillator Use After Myocardial Infarction in Older Adults

by PWeekly | Aug 31, 2016

According to current estimates, more than 350,000 people experience sudden cardiac death in the United States each year. Patients with low ejection fraction (EF) are at risk for sudden cardiac death, and clinical trials have established that implantable cardioverter-defibrillators (ICDs) improve survival for these individuals. Guidelines recommend ICDs as primary prevention for patients with an EF of 35% or lower if they do not improve after being treated with optimal medical therapy for at least 40 days after a myocardial infarction (MI). Studies suggest that ICDs are underutilized in routine clinical practice, especially after a patient suffers an MI. The incidence of MI and the resulting sequelae from these events increase with age. The benefit of ICDs as primary prevention is controversial among older patients because this population is underrepresented in clinical trials. Clinicians may be uncertain about the efficacy of ICDs in an older patient population and must also consider treatment goals and procedural risks. These factors may discourage the use of ICDs among older adults. A Closer Look In a retrospective study published in JAMA, Sean D. Pokorney, MD, MBA, and colleagues examined data from Medicare beneficiaries with an EF of 35% or less after MI. Participants were treated at 441 U.S. hospitals between 2007 and 2010, but were excluded if they had a prior ICD implant. The investigators evaluated the incidence and hospital variation of 1-year ICD implantation after MI among potentially eligible patients. They also examined factors that were linked to 1-year ICD implantation and compared 2-year mortality between patients with and without ICDs. The study was unique in that it evaluated the use...

Long-Term Trends in AMI Rehospitalization

by PWeekly | Aug 2, 2016

Coronary heart disease (CHD) continues to be a leading cause of morbidity and mortality in the United States, and acute myocardial infarction (AMI) is a common manifestation of CHD, affecting more than 800,000 American adults in 2010. “Concomitant with advances in pre-hospital and hospital treatment, in-hospital survival after AMI has dramatically improved,” says Han-Yang Chen, PhD. “However, many patients are being discharged from the hospital into the community despite being at risk for readmission due to a variety of contributory factors and reasons.” Dr. Chen adds that excess hospital readmissions are an indicator of potentially poor health care quality or inadequate coordination of post-discharge care. This is costly and represents a significant burden to both patients and the healthcare system. Since June 2009, CMS began publicly reporting 30-day risk-standardized readmission rates for AMI as one of the major hospital performance measures. The Affordable Care Act has created new payment penalties to reduce readmissions. Hospitals with excess readmissions can lose up to 3% of their Medicare reimbursement by 2015. “As a result, there has been considerable interest to better understand and improve modifiable factors associated with 30-day hospital readmissions, which are increasingly being linked to hospital reimbursement,” says Dr. Chen. Examining Decade-Long Trends In a study published in the Journal of the American Heart Association, Dr. Chen and colleagues sought to describe decade-long trends in 30-day rehospitalization rates among patients surviving hospitalization for an AMI from 2001 to 2011. They also described patient characteristics, clinical factors, and treatment practices associated with an increased risk of 30-day rehospitalization among residents of the Worcester, Massachusetts, metropolitan area discharged from three principal...

CME: Gender, Stress, & Acute Myocardial Infarction

by PWeekly | Jun 7, 2016

Studies have shown that women and younger patients are at increased risk for mental stress when compared with the male or older counterparts, respectively. Whether or not the same holds true for young and middle-aged patients presenting with acute myocardial infarction (AMI) has not been well established. “In general, psychosocial factors are increasingly recognized as important influences on patients’ health status and recovery after major health events,” says Xiao Xu, PhD. “However, studies focusing on AMI tend to recruit older patients. Therefore, little is known about how psychosocial factors may influence outcomes among younger people with AMI.” A Look at Younger Patients Dr. Xu and colleagues conducted a study that looked at the implications of stress on health outcomes and recovery in younger AMI patients. Published in Circulation, the authors used data from the VIRGO (Variation in Recovery: Role of Gender on Outcomes in Young AMI Patients) study. “VIRGO is the largest prospective study that has been conducted in the relatively younger AMI patient population,” Dr. Xu explains. “When that data became available, it presented an ideal opportunity to conduct our analysis. Because the VIRGO study focused on a uniquely large sample of young and middle-age patients, we were able to look at how stress is associated with recovery at 1 month in a younger population and also assess how gender affects outcomes.” For the study, the researchers examined gender differences in stress, factors contributing to these differences, and whether these differences helped explain gender-based disparities observed in 1-month recovery after AMI. Data on more than 3,500 AMI patients aged 18 to 55 were assessed. Self-perceived psychological stress...

Sex Differences & Cardiac Risks

by PWeekly | Jun 3, 2016

According to an American Heart Association survey, only 56% of women recognize heart disease as a leading cause of death among females and fewer than half consider themselves well informed about it. Educational campaigns have been launched to increase awareness of heart disease among women, but studies indicate that younger women with acute myocardial infarction (AMI) risk factors often do not receive counseling on their risk of cardiac events or ways to modify their risk. “AMI is less common among younger women, but outcomes for these patients tend to be worse than those for similarly aged men,” says Erica C. Leifheit-Limson, PhD. Among young patients with AMI, few investigations have looked specifically at differences between sexes with regard to cardiac risk factors, perceptions of cardiac risk, and healthcare provider discussions about these risks. To address this issue, Dr. Leifheit-Limson and colleagues had a study published in the Journal of the American College of Cardiology that examined these associations among young women and men who were hospitalized with AMI. Making Comparisons For the study, the authors compared the prevalence of several cardiac risk factors by sex in 3,501 AMI patients aged 18 to 55. The participants, who presented to hospitals in the United States and Spain, were enrolled in the Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study, and data were examined between August 2008 and January 2012. Baseline data were gathered from VIRGO participants using medical charts, in-person interviews, and their prior medical history. During the baseline interview, patients were asked about their personal perceptions of risk and discussion of heart disease risk...

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