Disability, race/ethnicity, and medication adherence among Medicare myocardial infarction survivors

• Published in: The American heart journal 2012-09, Vol.164 (3), p.425-433.e4
• Main Authors: Zhang, Yuting, PhD, Baik, Seo Hyon, PhD, Chang, Chung-Chou H., PhD, Kaplan, Cameron M., PhD, Lave, Judith R., PhD
• Format: Article
• Language: English
• Subjects: Adrenergic beta-Antagonists - therapeutic use; Adult; Aged; Aged, 80 and over; Angiotensin II Type 1 Receptor Blockers - therapeutic use; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Biological and medical sciences; Cardiology. Vascular system; Cardiovascular; Cohort Studies; Continental Population Groups - statistics & numerical data; Coronary heart disease; Disabled Persons - statistics & numerical data; Drug therapy; Ethnic Groups - statistics & numerical data; Female; Heart; Heart attacks; Hospitals; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Income - statistics & numerical data; Male; Medical sciences; Medicare; Medicare - statistics & numerical data; Medication Adherence - ethnology; Middle Aged; Myocardial Infarction - drug therapy; Myocardial Infarction - ethnology; Myocardial Infarction - mortality; Myocarditis. Cardiomyopathies; United States
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2012.05.021

Background Long-term medication therapy for patients with post–myocardial infarction (MI) can prolong life. However, recent data on long-term adherence are limited, particularly among some subpopulations. We compared medication adherence among Medicare MI survivors by disability status, race/ethnicity, and income. Methods We examined 100% of Medicare fee-for-service beneficiaries discharged post-MI in 2008. The outcomes were adherence to β-blockers, statins, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, for 1-year and 6-month postdischarge. Adherence was defined as having prescriptions in possession for ≥ 75% of days. Results Among aged beneficiaries who survived 1-year adherence to β-blockers were 68%, 66%, 61%, 58%, and 57% for whites, Asians, Hispanics, Native Americans, and blacks, respectively; among persons with disability, 1-year adherence was worse for each group: 59%, 54%, 52%, 47%, and 43%, respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location, and health status. Patterns of adherence to statins and angiotensin-converting enzymes/angiotensin II receptor blockers were similar. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to whites: odds ratio 0.70 (95% CI 0.65-0.75) for blacks and odds ratio 0.70 (95% CI 0.55-0.90) for Native Americans. Conclusions Although β-blockers at discharge has improved since the National Committee for Quality Assurance implemented quality measures, long-term adherence remains problematic, especially among persons with disability and minority beneficiaries. Quality measures for long-term adherence should be created to improve outcomes in patients with post-MI. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.