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Elderly women, minorities less adherent to acute MI therapy
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In the 12 months after hospital discharge, elderly black and Hispanic women have significantly lower adherence to acute MI treatment regimens than other similarly aged patients, according to data from a recent retrospective cohort study.
No significant differences in compliance were observed according to race/ethnicity alone, but black and Hispanic women had the lowest rate of adherence at 12 months, despite the implementation of the Medicare Part D prescription program.
Researchers analyzed Medicare service claims submitted between 2007 and 2009 by 85,017 Medicare enrollees aged 65 years or older. All patients were hospitalized in 2008 for acute MI and were alive 30 days after discharge.
The following treatment regimens were identified as secondary prevention therapies following hospitalization: beta-blockers, lipid-lowering agents, ACE inhibitors, angiotensin receptor blockers and low-dose aspirin. Compliance with each treatment regimen after discharge was calculated using refill records in the prescription Part D claims, or until death within 12 months of discharge.
Within 30 days after hospitalization, 55% of patients used ACE inhibitors/angiotensin receptor blockers, 76% used beta-blockers and 61% used statins. At this point, there were no marked disparities in the use of secondary therapies among race/ethnicity and gender groups; however, white and black women were less likely to use ACE inhibitors/angiotensin receptor blockers and beta-blockers than white men, whereas Hispanic women were more likely to use ACE inhibitors/angiotensin receptor blockers and Asian women were more likely to use statins.
At 12 months after acute MI discharge, patients were adherent to treatment in 63% of cases among ACE inhibitors/angiotensin receptor blockers users, 66% of beta-blocker users and 66% of statin recipients. Black and Hispanic women had the poorest rates of adherence compared with white men, ranging from 30% to 36% lower adherence for different therapies (P<.05). Significantly lower adherence also was observed among white and Asian women and women of other ethnicities, as well as black and Hispanic men, ranging from 9% to 27% lower compared with white men (P<.05). There was no significant difference in therapy adherence between white men and Asian men or those of other ethnicities.
Besides urging the further reduction of differences in care across racial groups, the researchers emphasized the need to improve treatment adherence among women.
“This finding may suggest a continued controversy of women receiving less aggressive treatment with preventive therapies than men for acute MI, even though the mortality risk after [acute] MI is higher in women,” the researchers wrote.
Disclosure: Lauffenburger receives support from the National Institute of Nursing Research. Another researcher reports receiving research grants awarded to the University of Iowa from Abbott, Daiichi-Sankyo, Esperion, GlaxoSmithKline and Merck.
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