High-income patients had higher adherence to secondary prevention after AMI than low-income patients for lipid-lowering drugs (HR 1.29, 1.12-1.49) and ACE-inhibitors (HR 1.22, 1.04-1.43).
Cohort (n=1,346)
Does high income improve adherence to secondary preventive therapy in patients after an AMI?
Higher socioeconomic position is associated with better adherence to secondary preventive therapies like lipid-lowering drugs and ACE-inhibitors after an AMI, highlighting inequities in healthcare access.
Effect estimate: HR 1.29 (lipid-lowering); HR 1.22 (ACE-inhibitor) (95% CI 1.12-1.49 (lipid-lowering); 1.04-1.43 (ACE-inhibitor))
PURPOSE: To investigate the association between socioeconomic position and use of lipid-lowering drugs and ACE-inhibitors after an acute myocardial infarction (AMI) when simultaneously considering participation in the national quality register RIKS-HIA (Register of Information and Knowledge about Swedish Heart Intensive care Admissions), age, sex and previous hospitalizations of the patients. METHODS: Population-based prospective cohort study included all 1346 AMI patients cared in the county of Scania, Sweden during 2006 of whom 1061 were register at the RIKS-HIA. Treatment with lipid-lowering and ACE-inhibiting therapy in relation to income was investigated with Cox and logistic regression modelling. RESULTS: In the whole population of AMI patients, high income patients had a higher adherence to guidelines for pharmacological secondary prevention than low income patients (HR(lipid-lowering drug): 1.29; 95%CI: 1.12-1.49 and HR(ACE-inhibitor therapy): 1.22; 95%CI: 1.04-1.43). Among RIKS-HIA participants, patients with high income presented a better adherence to lipid-lowering treatment than patients with low income (HR: 1.15; 95%CI: 0.98-1.34). CONCLUSION: Our investigation reveals that the Swedish goal of access to health care on equal terms and according to needs is still not fully accomplished. Moreover, since this pattern of inequity in pharmacological secondary prevention may lead to the recurrence of heart disease, these inequities are not only a matter of fairness and social justice, but also a potential (and modifiable) source of ineffectiveness and inefficiency in health care.
Ohlsson et al. (Tue,) conducted a cohort in Acute myocardial infarction (AMI) (n=1,346). High income vs. Low income was evaluated on Adherence to guidelines for pharmacological secondary prevention (lipid-lowering drugs and ACE-inhibitors) (HR 1.29 (lipid-lowering); HR 1.22 (ACE-inhibitor), 95% CI 1.12-1.49 (lipid-lowering); 1.04-1.43 (ACE-inhibitor)). High-income patients had higher adherence to secondary prevention after AMI than low-income patients for lipid-lowering drugs (HR 1.29, 1.12-1.49) and ACE-inhibitors (HR 1.22, 1.04-1.43).