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Stacie L. Daugherty, MD, MSPH; P. Michael Ho, MD, PhD; John A. Spertus, MD, MPH; Philip G. Jones, MS; Richard G. Bach, MD; Harlan M. Krumholz, MD, SM; Eric D. Peterson, MD, MPH; John S. Rumsfeld, MD, PhD; Frederick A. Masoudi, MD, MSPH

Arch Intern Med. 2008;168(5):485-491.

Background  Early outpatient follow-up after acute myocardial infarction (AMI) is recommended in guidelines, but its relationship with the use of evidence-based therapies is unknown.

Methods  We evaluated 1516 patients hospitalized with AMI from the multicenter Prospective Registry Evaluating Outcomes After Myocardial Infarction: Events and Recovery registry. Early follow-up was defined as patient- reported visits with a primary care physician or cardiologist within 1 month after discharge. The primary outcomes were use of aspirin, β-blockers, angiotensin-converting enzyme inhibitors, and statins in eligible patients at 6 months. Multivariable analyses assessed the association between early follow-up and medication use at 6 months, adjusting for patient and clinical characteristics. Secondary analyses compared medication use at 6 months for patients receiving collaborative follow-up from a single provider vs those receiving follow-up from both provider types.

Results  Among the cohort, 34% reported no outpatient follow-up during the month following discharge. Rates of medication prescription among appropriate candidates were similar at hospital discharge for both follow-up groups. Compared with those not receiving early follow-up, those receiving early follow-up were more likely to be prescribed β-blockers (80.1% vs 71.3%; P = .001), aspirin (82.9% vs 77.1%; P = .01), or statins (75.9% vs 68.6%; P = .005) at 6 months. In multivariable analyses, a persistent relationship remained between early follow-up and β-blocker use (risk ratio, 1.08; 95% confidence interval, 1.02-1.15). In secondary analyses, statin use was higher in patients receiving collaborative follow-up (risk ratio, 1.11; 95% confidence interval, 1.01-1.22).

Conclusions  Early outpatient follow-up and collaborative follow-up after AMI is associated with higher rates of evidence-based medication use. Although further studies should assess whether this relationship is causal, these results support current guideline recommendations for follow-up after AMI.

Author Affiliations: Departments of Medicine, Divisions of Cardiology, University of Colorado Denver Health Sciences Center (Drs Daugherty, Ho, Rumsfeld, and Masoudi); Denver VA Medical Center (Drs Ho and Rumsfeld); University of Missouri, Kansas City (Dr Spertus); Washington University Medical Center, St Louis, Missouri (Dr Bach); Yale University School of Medicine, New Haven, Connecticut (Dr Krumholz); Duke University School of Medicine, Durham, North Carolina (Dr Peterson); Denver Health Medical Center (Dr Masoudi); and Mid America Heart Institute, Cardiovascular Research, Kansas City (Dr Spertus and Mr Jones).

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