Mortality and healthcare resource utilization following acute myocardial infarction according to adherence to recommended medical therapy guidelines

Guideline recommended medical therapy (GRMT) plays a pivotal role in improving long-term outcomes and healthcare burden of acute myocardial infarction (AMI) patients. We evaluated patients’ adherence to GRMT following AMI and the association with long-term (up-to 10 years) mortality, healthcare resource utilization and costs. Methods: AMI patients hospitalized in a tertiary medical center in Israel that survived at least a year following post-discharge and enrolled in the two largest health plans were analyzed. Data were obtained from computerized medical records. Patients were defined as adherent when ≥80 % of the GRMT prescriptions were issue during the first post-discharge year. Hospitalizations, emergency department (ED) visits, primary care utilization and outpatient consulting clinic and other ambulatory services expenditure were calculated annually. Results: Overall 8287 patients qualified for the study (mean age 65.0 ± 13.6 years, 69.7 % males). Adherent patients (n = 1767, 21.3 %) were more likely to be younger, women and increased prevalence of most traditional cardiovascular risk factors. Throughout the follow-up, 2620 patients (31.6 %) died, 22.0 % versus 34.2 %, in the adherent vs. the non-adherent group (adjHR = 0.816, 95 % CI:0.730−0.913, p < 0.001). Reduced hospitalizations (adjOR = 0.783, p < 0.001), ED visits (adjOR = 0.895, p = 0.033), and costs (adjOR = 0.744, p < 0.001), yet increased primary clinics (adjOR = 2.173, p < 0.001) ambulatory (adjOR = 1.072, p = 0.018) and consultant (adjOR = 1.162, p < 0.001) visits, were observed. Conclusions: Adherence to GRMT following AMI is associated with decreased mortality, hospitalizations and costs.