Persistence of Beta-Blocker Treatment After a Heart Attack (PBH)

The percentage of persons 18 years of age and older during the measurement period who were hospitalized and discharged from July 1 of the year prior to the measurement period to June 30 of the measurement period with a diagnosis of AMI and who received persistent beta-blocker treatment for 180 days (6 months) after discharge. 

Why It Matters

According to results of large-scale clinical trials, beta-blockers consistently reduce subsequent coronary events after an acute myocardial infarction (AMI) when taken for at least 3 years in patients with normal left ventricle function (1,2). Literature suggests that, historically, adherence to beta-blockers declines significantly within the first year (3,4,5). 

About half of AMI survivors who are eligible for beta-blocker therapy do not receive it. Test data reveal significant underutilization of beta-blockers 180 days post-MI. There is evidence suggesting that around 2,900–5,000 lives are lost in the United States in the first year following AMI, from under-prescribing of beta-blockers (6). 

Per the ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction and Guidelines for the Management of Patients With Acute Myocardial Infarction, long-term beta-blocker therapy should begin within the first 24 hours in patients with ST-segment elevation MI in absence of heart failure (5). In the 2011 update to the Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease, the AHA and ACCF indicated that beta-blocker therapy should be started and continued for 3 years in all patients with normal left ventricle function who have had AMI (6). 

The key to improving rate of use of beta-blockers is for organizations to educate providers about the value of these agents, to offer incentives to encourage their appropriate and timely use and to provide physicians with guidelines and other decision support tools that will help them prescribe drugs appropriately. In addition, organizations can ensure that beta-blocker medications are available on their prescription drug formularies. 

Historical Results – National Averages

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References

  1. O’Gara, P.T., F.G. Kushner, D.D. Ascheim, D.E. Casey, M.K. Chung, J.A. de Lemos, S.M. Ettinger, et al. January 29, 2013. “2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.” Circulation 127, no. 4. https://doi.org/10.1161/CIR.0b013e3182742cf6
  2. Smith, S.C., E.J. Benhamin, R.O. Bonow, L.T. Braun, M.A. Creager, B.A. Franklin, R.J. Gibbons, et al. November 29, 2011. “AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients With Coronary and Other Atherosclerotic Vascular Disease: 2011 Update: A Guideline From the American Heart Association and American College of Cardiology Foundation.” Circulation 124, no. 22: 2458–73. https://doi.org/10.1161/CIR.0b013e318235eb4d.
  3. Krumholz, H.M., M.J. Radford, Y. Wang, J. Chan, A. Heiat, T.A. Marciniak. 1998. “National Use and Effectiveness of Beta-Blockers for the Treatment of Elderly Patients After Acute Myocardial Infarction.” National Cooperative Cardiovascular Project. JAMA 280:623–9.
  4. Norwegian Multicenter Study Group. 1994. “Timolol-Induced Reduction in Mortality and Reinfarction in Patients With Acute Myocardial Infarction 1998–1992.” J Am Coll Cardiol 23:1023–30.
  5. Yusef, S., J. Wittes, L. Friedman. 1988. “Overview of Results of Randomized Clinical Trials in Heart Disease.” JAMA 260:2088–93.
  6. Bradford, W.D., J. Chen, H.M. Krumholz. 1999. “Under-Utilisation of Beta-Blockers After Acute Myocardial Infarction. Pharmacoeconomic Implications.” Pharmacoeconomics Mar;15(3):257–68.

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