Abstract 17339: Persistence of Evidence Based Medications after Non-ST Elevation Myocardial Infarction among Patients with Medicare Part D Prescription Coverage

Abstract

Background_ Persistent use of evidence-based medications (EBM) is a key metric of successful transition of patients following acute myocardial infarction, particularly for older patients.

Methods_We linked patients aged ≥65 years discharged home after NSTEMI in 2006 in the CRUSADE Registry to Medicare pharmacy claims data (Part D) and examined filling of prescriptions within 90 days and persistence at 1 year after discharge for EBMs, including clopidogrel, beta-blocker, ACEI/ARB, and statin. We then compared long-term mortality (median follow-up 814 days) between patients with and without 1 year EBM persistence.

Results_Among 2,617 NSTEMI patients with Medicare part D coverage, the median age was 76 years (IQR 71 to 82), 55% were female, and 82% were Caucasian. Within 90 days of discharge, approximately 80% of patients prescribed each EBM filled the prescription (Table). By 1 year, approximately a third of patients had discontinued each of the EBM prescribed at hospital discharge. This rate was consistent among EBM classes, and consistently lower for medications initiated versus continued during the index NSTEMI hospitalization. Overall 1-year persistence of all EBMs prescribed at discharge was low (41.4%). Long-term mortality for patients persistent with EBMs at 1 year was 14.2% vs. 17.4% for non-persistent patients, p=0.06 without significant differences in baseline demographic and clinic characteristics between groups.

Conclusion_More than half of older patients are not persistent with EBMs a year after NSTEMI discharge. Patients who are non-persistent with EBMs are associated with worse long-term outcomes and thus important targets for future quality improvement.