Predictors of adherence to performance measures in patients with acute myocardial infarction

Dharam J. Kumbhani, Gregg C. Fonarow, Christopher P. Cannon, Adrian F. Hernandez, Eric D. Peterson, W. Frank Peacock, Warren K. Laskey, Wenqin Pan, Lee H. Schwamm, Deepak L. Bhatt

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

Background: There have been substantial improvements in the use of evidence-based, guideline-recommended therapies for patients with acute myocardial infarction. Nevertheless, some gaps, disparities, and variations in use remain. To understand how such gaps in recommended care may be narrowed further, it may be useful to determine those factors associated with lessened adherence to guideline-based care. Methods: The Get with the Guidelines-Coronary Artery Disease registry measured adherence with 6 performance measures (aspirin within 24 hours, discharge on aspirin and beta-blockers, patients with low ejection fraction discharged on angiotensin-converting enzyme inhibitor/angiotensin receptor blocker, smoking cessation counseling, use of lipid-lowering medications) in 148,654 patients with acute myocardial infarction between 2002 and 2009. Logistic multivariable regression models using generalized estimating equations were utilized to identify patient and hospital characteristics associated with adherence to each of 6 measures, and to a summary score of performance for all measures, in eligible patients. Results: We identified 10 variables that were associated significantly with either greater adherence (hypertension, hyperlipidemia, hospital with full interventional capabilities, calendar year) or worse adherence (age, female sex, congestive heart failure, chronic renal insufficiency, atrial fibrillation, chronic dialysis) in at least 4 of the 6 treatment adherence models, as well as the summary score adherence model. Age, sex, and calendar year were significant in all models. Conclusions: Use of evidence-based acute myocardial infarction treatments remains less than ideal for certain high-risk populations. The close correlations among factors associated with underperformance highlights the potential for specifically targeting and tailoring quality improvement interventions.

Original languageEnglish (US)
JournalAmerican Journal of Medicine
Volume126
Issue number1
DOIs
StatePublished - Jan 2013

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Myocardial Infarction
Aspirin
Guidelines
Guideline Adherence
Angiotensin Receptor Antagonists
Smoking Cessation
Quality Improvement
Hyperlipidemias
Chronic Renal Insufficiency
Angiotensin-Converting Enzyme Inhibitors
Atrial Fibrillation
Registries
Counseling
Coronary Artery Disease
Dialysis
Therapeutics
Heart Failure
Logistic Models
Hypertension
Lipids

Keywords

  • Arteriosclerosis
  • Myocardial infarction
  • Risk factors
  • Sex
  • Statins

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Kumbhani, D. J., Fonarow, G. C., Cannon, C. P., Hernandez, A. F., Peterson, E. D., Peacock, W. F., ... Bhatt, D. L. (2013). Predictors of adherence to performance measures in patients with acute myocardial infarction. American Journal of Medicine, 126(1). https://doi.org/10.1016/j.amjmed.2012.02.025

Predictors of adherence to performance measures in patients with acute myocardial infarction. / Kumbhani, Dharam J.; Fonarow, Gregg C.; Cannon, Christopher P.; Hernandez, Adrian F.; Peterson, Eric D.; Peacock, W. Frank; Laskey, Warren K.; Pan, Wenqin; Schwamm, Lee H.; Bhatt, Deepak L.

In: American Journal of Medicine, Vol. 126, No. 1, 01.2013.

Research output: Contribution to journalArticle

Kumbhani, DJ, Fonarow, GC, Cannon, CP, Hernandez, AF, Peterson, ED, Peacock, WF, Laskey, WK, Pan, W, Schwamm, LH & Bhatt, DL 2013, 'Predictors of adherence to performance measures in patients with acute myocardial infarction', American Journal of Medicine, vol. 126, no. 1. https://doi.org/10.1016/j.amjmed.2012.02.025
Kumbhani, Dharam J. ; Fonarow, Gregg C. ; Cannon, Christopher P. ; Hernandez, Adrian F. ; Peterson, Eric D. ; Peacock, W. Frank ; Laskey, Warren K. ; Pan, Wenqin ; Schwamm, Lee H. ; Bhatt, Deepak L. / Predictors of adherence to performance measures in patients with acute myocardial infarction. In: American Journal of Medicine. 2013 ; Vol. 126, No. 1.
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