Minority Patients, Women Less Likely to Remain Adherent After Heart Attack

Women and members of racial and ethnic minorities were generally less likely to be adherent to medications than were white men a year after having a heart attack, a new study finds.

The results of a recent study suggest that minority patients are less likely to remain adherent to their medications 1 year after a heart attack than are white patients. The study found that black and Hispanic women had the lowest levels of medication adherence following a heart attack.

Despite the implementation of the Medicare Part D prescription drug program, research has shown that minority patients and women continue to suffer worse outcomes after heart attacks compared with white men. The new study, published online on December 10, 2013, in Circulation, assessed whether these differences in outcomes could be due to differences in adherence based on race, ethnicity, and gender.

The retrospective study included Medicare beneficiaries aged 65 and older who were hospitalized for acute myocardial infarction during 2008 and who had prescription claims within 30 days of discharge. The researchers categorized patients as white, black, Hispanic, Asian, and other. Then they evaluated differences in use and adherence to statins, beta-blockers, and angiotensin-converting-enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs). Adherence was also analyzed according to participants’ gender. Adherence was calculated from prescription refill records and was defined as 80% or greater medication coverage throughout the year of follow-up. The researchers also analyzed whether factors such as whether patients follow up with a cardiologist or primary care physician and the total cost of medication affect the relationship between a patient’s gender, race, and ethnicity and their adherence to medications after heart attack.

The results indicated that although the different medication types were prescribed at similar rates among each racial/ethnic group, there were significant differences in adherence among the groups after 1 year. Women were less likely to use beta-blockers and ACE inhibitors and ARBs when compared with white men and were also less likely to remain adherent to most medications within all racial and ethnic groups.

One year after discharge, black and Hispanic women were the least likely to still be taking their medications. Compared with white men, black women were 30% less likely and white women and black men were approximately 10% less likely to remain adherent to ACE inhibitors and ARBs, and black and Hispanic women were 36% and 30% less likely to be adherent to beta-blockers, respectively. Black and Hispanic men and black, Hispanic, and other women were approximately 30% less adherent to statins than white men. Although women of all racial and ethnic categories were less adherent than white men in all other medication categories, white women were 5% more likely than white men to be adherent to statins. There were no significant differences in adherence to any therapy between white and Asian men.

The researchers also found that follow-up with a cardiologist or physician and patient out-of-pocket medication costs did not affect the relationship between adherence and race, ethnicity, and gender.

Although the implementation of the Medicare Part D prescription drug program seems to have eliminated gaps in treatment initiation among different racial, ethnic, and gender groups, the results of the study suggest that significant gaps remain in continuing care after heart attack. The study authors note that physicians may have different attitudes when treating women after heart attacks, and that the women themselves may have different beliefs about the severity of their condition and the effects of the medications when compared with men.

“Clinicians, researchers, and policy-makers should continue to focus attention on eliminating differences in care following [acute myocardial infarction], even months after the initial event,” they conclude.