B-blocker Compliance Post-MI: Costs, Causes, Disparities

MI 后 B 受体阻滞剂合规性：成本、原因、差异

• 批准号: 6902184
• 负责人: WILLIAM B. VOGT
• 金额: $ 6.51万
• 依托单位: CARNEGIE-MELLON UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-09-01 至 2007-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6902184
• 关键词: age difference; behavioral /social science research tag; beta antiadrenergic agent; clinical research; gender difference; geographic difference; health care cost /financing; health care service utilization; health disparity; health insurance; health services research tag; heart disorder chemotherapy; human data; human mortality; human subject; myocardial infarction; patient care personnel relations; physicians; racial /ethnic difference; therapy compliance

Heart disease is the leading cause of death among Americans 65 and older and the second leading cause of death in the 45-64 age group. A substantial fraction of these deaths are due to acute myocardial infarction. Long-term beta blocker therapy after AMI is a proven method for reducing mortality, cardiovascular mortality, and repeat AMI. Short-term compliance with beta-blocker therapy is good and improving, but recent studies show that in the year after AMI compliance with beta-blocker therapy drops sharply: half or fewer of patients are compliant at one year post-AMI. Furthermore, little is known about the causes or consequences of this decline. Given the widespread age, sex, and racial disparities in treatment and outcome for heart disease, disparities in compliance may be particularly salient. In an observational, retrospective setting using claims data from a large health insurer, therefore, we aim to: 1) measure the difference in healthcare costs between patients compliant and non-compliant with long-term beta-blocker therapy post-AMI. 2) measure disparities in compliance based upon age, sex, race, income, and insurance status. 3) measure how compliance varies with the characteristics of a patient's physician and with the characteristics of the physician-patient interaction. 4) decompose the variation in compliance into physician-specific and patient-specific components. 5) measure differences in mortality, reinfarction, and readmission between compliant and non-compliant patients, in order to assess selection bias in our data.

心脏病是65岁及以上美国人的主要死因，也是45-年龄段的第二大死因。这些死亡中有很大一部分是由急性心肌梗塞引起的。急性心肌梗死后长期应用β受体阻滞剂是一种有效的降低死亡率、心血管病死率和再发心肌梗死的方法。对β-受体阻滞剂治疗的短期依从性是好的，而且正在改善，但最近的研究表明，在急性心肌梗死后的一年里，对β-受体阻滞剂治疗的依从性急剧下降：一半或更少的患者在急性心肌梗死后一年依从性。此外，人们对这种下降的原因或后果知之甚少。鉴于心脏病的治疗和结局中普遍存在的年龄、性别和种族差异，依从性方面的差异可能特别突出。因此，在使用一家大型健康保险公司的索赔数据的观察性、回溯性设置中，我们的目标是：1)衡量急性心肌梗死后长期服用β-受体阻滞剂治疗的患者之间的医疗费用差异。2)根据年龄、性别、种族、收入和保险状况衡量合规方面的差异。3)测量依从性如何随患者医生的特征和医患互动的特征而变化。4)将依从性的变化分解为医生特定的部分和患者特定的部分。5)测量依从性和非依从性患者在死亡率、再梗塞和再入院方面的差异，以评估我们数据中的选择偏倚。