Association of Early Follow-up After Acute Myocardial Infarction With Higher Rates of Medication Use—Invited Commentary

Of the estimated 1.2 million Americans expected to experience a coronary event in 2007, approximately half a million will experience recurrent cardiac events.¹ Thus, improvements in secondary prevention efforts that lead to reductions in these numbers carry considerable public health implications. Current guidelines recommend that low-risk patients return for follow-up shortly after discharge,^2- 3 and some guidelines² recommend that higher-risk patients return 2 weeks after discharge. In this issue of the Archives, Daugherty et al examined data from a multicenter registry of 1516 patients hospitalized for acute myocardial infarction (AMI). Patients who reported an outpatient visit with a primary care physician or cardiologist within 1 month of discharge were defined as having received early follow-up. The primary outcomes of interest were receipt of evidence-based medications that are beneficial in treating cardiac conditions (including aspirin, β-blockers, angiotensin-converting enzyme [ACE] inhibitors, and statins) in eligible patients at 6 months after discharge. A substantial number of patients (over 30%) received no early follow-up care. Although rates of receipt of cardiac medications at the time of hospital discharge were similar among those who received early follow-up compared with those who did not, at 6 months these rates were lower for those patients who did not visit a physician within a month of discharge. In addition to early follow-up, shared care (ie, being seen by both a primary care physician and a cardiologist) was associated with improved rates of statin use at 6 months. The investigators concluded that early outpatient follow-up and outpatient follow-up with both a cardiologist and primary care physician resulted in improved rates of evidenced-based medication use.