Medication Initiation and Adherence for Young Women After MI

Study Questions:

Does post–myocardial infarction (MI) management differ for young women compared to other patients?

Methods:

This was a retrospective population-based cohort study using linked administrative data sets from British Columbia (2004 to 2011). Data included health care, prescription drugs, sociodemographic, and mortality information. Patients who were admitted to the hospital for acute MI between 2007 and 2009, and who survived 1 or more years post-discharge, were included in the study. Rates of filled prescriptions for angiotensin-converting enzyme inhibitors, beta-blockers, and statins were examined by gender.

Results:

A total of 13,524 patients were admitted with acute MI between 2007 and 2009, of which 12,261 (90.7%) survived for at least 1 year after discharge. Women tended to be older (~7 years) and less likely to be diagnosed with an ST-segment elevation MI than the men. Women were also more likely to be in the lowest income quintile than men. The majority of acute MI survivors initiated appropriate medications within 2 months of discharge from the hospital. Younger men were more likely to initiate treatment compared to younger women (adjusted odds ratio, 1.38; 95% confidence interval, 1.10–1.75). At the end of the first year post-discharge, only one third of all acute MI survivors filled all appropriate prescriptions for at least 80% of the year. Adherence to medications was similar between men and women.

Conclusions:

The investigators concluded that the majority of acute MI survivors either discontinue treatment or do not refill their prescriptions consistently. Women aged <55 years are significantly less likely to be on optimal therapy by the end of 1 year after discharge, which is driven by a sex disparity in treatment initiation and not treatment adherence.

Perspective:

These data suggest that a larger number of acute MI survivors are not taking evidenced-based cardiac medications consistently, and these findings are in line with prior studies. Finding methods to improve adherence has significant public health implications.

Clinical Topics: Acute Coronary Syndromes, Clinical Topic Collection: Dyslipidemia, Prevention, Nonstatins, Novel Agents, Statins

Keywords: Acute Coronary Syndrome, Adrenergic beta-Antagonists, Angiotensin-Converting Enzyme Inhibitors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Medication Adherence, Myocardial Infarction, Prescription Drugs, Secondary Prevention, Survivors, Women


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