Dataset Information

Income-related inequity in initiation of evidence-based therapies among patients with acute myocardial infarction.

ABSTRACT:

Background

Previous research has shown a socioeconomic status (SES) gradient in the receipt of cardiac services following acute myocardial infarction (AMI), but much less is known about SES and the use of secondary preventive medicines following AMI.

Objectives

To examine the role of income in initiation of treatment with ACE-inhibitors, beta-blockers and statins in the 120 days following discharge from hospital for first AMI.

Design

A cross-sectional study with a population-based cohort.

Participants

First-time AMI patients between age 40 and 100 discharged alive from the hospital and surviving at least 120 days following discharge between January 1, 1999 and September 3, 2006.

Main measures

Binary variables indicating whether the patient had filled at least one prescription for each of the medicines of interest.

Key results

Our results reveal a significant and positive income gradient with initiation of the guideline-recommended medicines among male AMI patients. Men in the third income quintile and above were significantly more likely to initiate treatment with any of the medicines than those in the first quintile, with those in the fifth income quintile having 37%, 50% and 71% higher odds of initiating ACE-inhibitors, beta-blockers and statins, respectively, than men in the lowest income quintile [OR = 1.37 95% CI (1.24, 1.51); OR = 1.50 95% CI (1.35, 1.68); and OR = 1.71 95% CI (1.53, 190)]. The gradient was not present among women, although women in the fifth income quintile were more likely to initiate beta-blockers and statins than women in the lowest income quintile [OR = 1.25 95% CI (1.06, 1.47) and OR = 1.32 95% CI (1.12, 1.54)].

Conclusions

There were inequities in treatment following AMI in the form of a clear and often significant gradient between income and initiation of evidence-based pharmacologic therapies among male patients. This gradient persisted despite significant changes in coverage levels for the costs of these medicines.

SUBMITTER: Hanley GE

PROVIDER: S-EPMC3208463 | biostudies-literature | 2011 Nov

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Income-related inequity in initiation of evidence-based therapies among patients with acute myocardial infarction.

Hanley Gillian E GE Morgan Steve S Reid Robert J RJ

Journal of general internal medicine 20110713 11

<h4>Background</h4>Previous research has shown a socioeconomic status (SES) gradient in the receipt of cardiac services following acute myocardial infarction (AMI), but much less is known about SES and the use of secondary preventive medicines following AMI.<h4>Objectives</h4>To examine the role of income in initiation of treatment with ACE-inhibitors, beta-blockers and statins in the 120 days following discharge from hospital for first AMI.<h4>Design</h4>A cross-sectional study with a populatio ...[more]

PMID: 21751053

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Project description:BackgroundOral antiplatelet therapy is the cornerstone of treatment for acute myocardial infaction (AMI). However, detailed usage data on oral antiplatelet therapy are lacking.MethodsUsing data from a nationally representative sample of patients with AMI, the detailed usage of oral antiplatelet therapy was analyzed in 40,202 consecutive eligible patients.ResultsThe proportions of patients with AMI taking loading doses of aspirin and P2Y12 inhibitors were relatively low (62.2% and 63.6%, respectively), whereas approximately 90% of patients received maintenance doses of aspirin, P2Y12 inhibitors, and dual antiplatelet therapy. The proportions of patients taking loading doses of aspirin and P2Y12 inhibitors gradually decreased with age. Male sex, an educational level of at least college, an interval from onset to treatment of < 24 h, and primary PCI use were associated with a higher proportion of patients taking a loading dose of antiplatelet therapy, whereas those receiving conservative treatment had a lower rate of antiplatelet use (all P < 0.05). The proportion of patients taking loading doses of aspirin was highest in the western region, and that of patients taking loading doses of P2Y12 inhibitors was highest in the eastern region (P < 0.05). In addition, 76.7% of patients with ST-elevation MI and 91% of patients with non-ST-elevation MI received 300-mg loading dose of clopidogrel.ConclusionsThe proportion of patients with AMI receiving loading doses of aspirin and P2Y12 inhibitors during hospitalization was relatively low, and this rate was affected by many factors, such as age, sex, educational level, region of residence, and the interval from onset to treatment. The underutilization of guideline-based P2Y12 inhibitors was also problematic. Hence, quality improvement initiatives are needed to enhance adherence to guidelines to improve consistent use of oral antiplatelet therapy. Trial registration The Chinese Acute Myocardial Infarction Registry; Trial registration number: ChiCTR-ONC-12002636; Registered 31 October 2012; http://www.chictr.org.cn/showproj.aspx?proj=6916.

Project description:BackgroundIn an accompanying article, we report moderate between-hospital variation in the postdischarge use of beta-blockers, angiotensin-modifying drugs and statins by elderly patients who had been admitted to hospital with acute myocardial infarction. Our objective was to identify the characteristics of patients, physicians, hospitals and communities associated with differences in the use of these medications after discharge.MethodsFor this retrospective, population-based cohort study, we used linked administrative databases. We examined data for all patients aged 65 years or older who were discharged from hospital in 2005/06 with a diagnosis of myocardial infarction. We determined the effect of patient, physician, hospital and community characteristics on the rate of postdischarge medication use.ResultsIncreasing patient age was associated with lower postdischarge use of medications. The odds ratios (ORs) for a 1-year increase in age were 0.98 (95% confidence interval [CI] 0.97-0.99) for beta-blockers, 0.97 (95% CI 0.97-0.98) for angiotensin-converting-enzyme inhibitors and angiotensin-receptor blockers and 0.94 (95% CI 0.93-0.95) for statins. Having a general or family practitioner, a general internist or a physician of another specialty as the attending physician, relative to having a cardiologist, was associated with lower postdischarge use of beta-blockers, angiotensin-modifying agents and statins (ORs ranging from 0.46 to 0.82). Having an attending physician with 29 or more years experience, relative to having a physician who had graduated within the past 15 years, was associated with lower use of beta-blockers (OR 0.71, 95% CI 0.60-0.84) and statins (OR 0.81, 95% CI 0.67-0.97).InterpretationPatients who received care from noncardiologists and physicians with at least 29 years of experience had substantially lower use of evidence-based drug therapies after discharge. Dissemination strategies should be devised to improve the prescribing of evidence-based medications by these physicians.

Dataset Information

Income-related inequity in initiation of evidence-based therapies among patients with acute myocardial infarction.

Background

Objectives

Design

Participants

Main measures

Key results

Conclusions

Publications

Income-related inequity in initiation of evidence-based therapies among patients with acute myocardial infarction.

Similar Datasets

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