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β-Blocker Compliance, Mortality, and Reinfarction: Validation of Clinical Trial Association Using Insurer Claims Data

Carnegie Mellon University, Pittsburgh, Pennsylvania, skleiner{at}andrew.cmu.edu

William B. Vogt, PhD

RAND Corporation, Pittsburgh, Pennsylvania

Patricia Gladowski, RN, MSN

Highmark Inc, Pittsburgh, Pennsylvania

Andrea DeVries, PhD

HealthCore Inc, Wilmington, Delaware

Gary Levin, MD, MBA

University of California, Davis

Christopher Antonucci, BA

Highmark Inc, Pittsburgh, Pennsylvania

John Fong, MD

Blue Cross and Blue Shield of North Carolina, Durham

Although randomized controlled trials show that long-term β-blocker use post acute myocardial infarction (AMI) reduces mortality and subsequent cardiovascular events, and that increased compliance lowers mortality, there is limited published research on the effects of long-term β-blocker compliance in observational community settings. The authors retrospectively study the effect of β -blocker compliance on mortality and repeat reinfarction using claims records from a major health insurer of all patients who were discharged alive after AMI between January 2003 and June 2004, covered by that health insurer’s prescription drug coverage, and prescribed β-blockers (n = 3923). Using Cox proportional hazards regressions, they estimate both survival and AMI-free survival rates by compliance quartile. Both survival and AMI-free survival rates diverge rapidly and are robust to adjustments for demographics, DxCG risk score, and other baseline risk factors. Results suggest that patients whose post-AMI compliance with β-blocker therapy is above average experience lower mortality and reinfarction. This is especially true for high-risk patients.

Key Words: statistics and research methods • health services research • survival analysis • pharmacology/β-blockers • pharmacology/drug adherence

American Journal of Medical Quality, Vol. 24, No. 6, 512-519 (2009)
DOI: 10.1177/1062860609345003


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