Racial/Ethnic and Gender Gaps in the Use of and Adherence to Evidence-Based Preventive Therapies Among Elderly Medicare Part D Beneficiaries After Acute Myocardial Infarction

Abstract

Background It is unclear whether gender and racial/ethnic gaps in the use of and patient adherence to β-blockers, angiotensin-converting-enzyme inhibitors (ACEIs)/angiotensin receptor blockers (ARBs), and HMG-CoA reductase inhibitors (statins) post-acute myocardial infarction (AMI) have persisted following establishment of the Medicare Part D prescription program. Methods and Results This retrospective cohort study used 2007-2009 Medicare service claims among Medicare beneficiaries ≥ 65 years who were alive 30 days after an index AMI hospitalization in 2008. Multivariable logistic regression models examined racial/ethnic (white, black, Hispanic, Asian, and Other) and gender differences in the use of these therapies in the 30 days post-discharge and patient adherence at 12-months post-discharge, adjusting for patient baseline sociodemographic and clinical characteristics. Out of 85,017 individuals, 55%, 76%, and 61% used ACEIs/ARBs, β-blockers, and statins within 30 days post-discharge, respectively. No marked differences in use were found by race/ethnicity but women were less likely to use ACEI/ARBs and β-blockers compared with men. However, at 12-months post-discharge compared with white men, black and Hispanic women had the lowest likelihood (approximately 30-36% lower, p <0.05) of being adherent, followed by white, Asian, and other women and black and Hispanic men (approximately 9-27% lower, p <0.05). No significant difference was shown between Asian/other men and white men. Conclusions While minorities were initially no less likely to use the therapies post-AMI discharge compared with white patients, black and Hispanic patients had significantly lower adherence over 12 months. Strategies to address gender and racial/ethnic gaps in the elderly are needed.

Sex Differences in Ischemic Heart Disease

“…This decreased adherence was postulated to be secondary to lack of social support, community resources, cognitive deficiencies, and physician follow-up. 50 Disparities in medication prescription and adherence might explain the sex differences for suboptimal outcomes post-MI.…”

Because Women’s Lives Matter, We Need to Eliminate Gender Bias

“…105 After AMI, women are less likely than men to receive ACE inhibitors, angiotensin receptor blockers, and β-blockers after discharge. 106 Women are less likely to receive primary PCI or CABG, 107 have longer symptom-onset-to-balloon time, more likely to receive only medical management, less likely to receive β-blockers or statins at discharge. 108 AHA's first Scientific Statement on Acute MI in Women, 109 notes that "despite dramatic declines in cardiovascular deaths among women over the past decade .…”

Improving Adherence to Cholesterol Lowering Medications among Minority Populations in Florida: A Randomized Trial

“…To date, much of the existing work in the area of cholesterol lowering medication is aimed at identifying newer more powerful agents or lowering the targets for intervention. Yet, as we and others have shown, one major existing gap in knowledge are interventions that can address the largest barrier to cholesterol lowering initiatives which are the low medication adherence rates even after the occurrence of acute cardiovascular events [24]. Poor adherence to statins among high risk groups has been associated high cardiovascular and all-cause mortality [25].…”

“…Thus, this translational and health disparity research study will provide timely information on a low cost approach to translate important clinical discoveries into every day clinical care. This is of particular importance among minority populations who have a higher prevalence of CVD risk factors, are less likely to receive evidence based interventions and more likely to experience worst CVD outcomes [5,24,[27][28][29].…”