Health Policy 124 (2020) 1200–1208 Contents lists available at ScienceDirect Health Policy j our na l ho me pag e: www.elsevier.com/locate/healthpol Mortality and healthcare resource utilization following acute myocardial infarction according to adherence to recommended medical therapy guidelines Ygal Plakht a,b,∗ , Dan Greenberg c , Harel Gilutz d , Jonathan Eli Arbelle d,e , Arthur Shiyovich f a Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel b Soroka University Medical Center, Beer-Sheva, Israel c Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel d Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel e Southern District, Maccabi Health Services, Beer-Sheva, Israel f Department of Cardiology, Rabin Medical Center, Petah Tikva, Israel, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel a r t i c l e i n f o Article history: Received 22 August 2019 Received in revised form 9 July 2020 Accepted 11 July 2020 Keywords: Acute myocardial infarction Adherence to medications Mortality Healthcare utilization Follow-up study a b s t r a c t Guideline recommended medical therapy (GRMT) plays a pivotal role in improving long-term outcomes and healthcare burden of acute myocardial infarction (AMI) patients. We evaluated patients’ adherence to GRMT following AMI and the association with long-term (up-to 10 years) mortality, healthcare resource utilization and costs. Methods: AMI patients hospitalized in a tertiary medical center in Israel that survived at least a year fol- lowing post-discharge and enrolled in the two largest health plans were analyzed. Data were obtained from computerized medical records. Patients were defined as adherent when ≥80 % of the GRMT prescrip- tions were issue during the first post-discharge year. Hospitalizations, emergency department (ED) visits, primary care utilization and outpatient consulting clinic and other ambulatory services expenditure were calculated annually. Results: Overall 8287 patients qualified for the study (mean age 65.0 ± 13.6 years, 69.7 % males). Adherent patients (n = 1767, 21.3 %) were more likely to be younger, women and increased prevalence of most traditional cardiovascular risk factors. Throughout the follow-up, 2620 patients (31.6 %) died, 22.0 % versus 34.2 %, in the adherent vs. the non-adherent group (adjHR = 0.816, 95 % CI:0.730−0.913, p < 0.001). Reduced hospitalizations (adjOR = 0.783, p < 0.001), ED visits (adjOR = 0.895, p = 0.033), and costs (adjOR = 0.744, p < 0.001), yet increased primary clinics (adjOR = 2.173, p < 0.001) ambulatory (adjOR = 1.072, p = 0.018) and consultant (adjOR = 1.162, p < 0.001) visits, were observed. Conclusions: Adherence to GRMT following AMI is associated with decreased mortality, hospitalizations and costs. © 2020 Elsevier B.V. All rights reserved. 1. Introduction Advancements in the management of patients with acute myocardial infarction (AMI) led to significantly improved outcomes [1,2]. However, hospital survivors of AMI continue to be a high-risk group with long-term mortality rate of more than twice higher than demographically matched general population [3]. Furthermore, ∗ Corresponding author at: Department of Nursing, Faculty of Health Sciences, Ben-Gurion University of the Negev. P.O.B. 653, Beer-Sheva, 84105, Israel. E-mail address: Plakht@bgu.ac.il (Y. Plakht). patients who experienced and survived AMI suffer from higher morbidity, utilize more healthcare services resulting in increased healthcare expenditure [3–5]. Secondary prevention, in particular guideline recommended medical therapy (GRMT) (e.g. Acetyl- salicylic acid [Aspirin], angiotensin-converting-enzyme inhibitors [ACE-I], beta-blockers and statins) to modify cardiovascular risk factors, has been suggested to play a pivotal role in improving long-term outcomes and healthcare burden of AMI patients [6–8]. Real life data of adherence rates with such medical treatment has been reported to be about 50 % or even less, with negative impact on patient outcomes [9–15], yet long-term data, specifically with healthcare resource utilization, are sparse. The purpose of the https://doi.org/10.1016/j.healthpol.2020.07.004 0168-8510/© 2020 Elsevier B.V. All rights reserved.