Key result
Elderly Chinese and South Asian AMI survivors were significantly less likely to adhere to ACE-inhibitors compared to Non-Asian patients (OR 0.53 and OR 0.78, respectively).
Why the study?
Does ethnicity affect adherence to secondary prevention medications in elderly AMI survivors?
Cohort (n=9,926)
Does ethnicity affect adherence to secondary prevention medications in elderly AMI survivors?
Odds Ratio: 0.53 (95% CI 0.39–0.73)
Absolute Event Rate: 63.5% vs 75%
p-value: p=<0.0001
Despite higher prescribing rates, elderly Chinese and South Asian AMI survivors are less likely to adhere to ACE inhibitors compared to Non-Asian patients, highlighting a need for targeted adherence support.
Ethnic disparities may warrant tailored adherence support in elderly AMI survivors; leaves open causal factors and need for prospective validation.
BACKGROUND: Failure to adhere to cardiac medications after acute myocardial infarction (AMI) is associated with increased mortality. Language barriers and preference for traditional medications may predispose certain ethnic groups at high risk for non-adherence. We compared prescribing and adherence to ACE-inhibitors (ACEI), beta-blockers (BB), and statins following AMI among elderly Chinese, South Asian, and Non-Asian patients. METHODS: Retrospective-cohort study of elderly AMI survivors (1995-2002) using administrative data from British Columbia. AMI cases and ethnicity were identified using validated ICD-9/10 coding and surname algorithms, respectively. Medication adherence was assessed using the 'proportion of days covered' (PDC) metric with a PDC ≥ 0.80 indicating optimal adherence. The independent effect of ethnicity on adherence was assessed using multivariable modeling, adjusting for socio-demographic and clinical characteristics. RESULTS: There were 9926 elderly AMI survivors (258 Chinese, 511 South Asian patients). More Chinese patients were prescribed BBs (79.7% vs. 73.1%, p = 0.04) and more South Asian patients were prescribed statins (73.5% vs. 65.2%, p = 0.001). Both Chinese (Odds Ratio [OR] 0.53; 95%CI, 0.39-0.73; p < 0.0001) and South Asian (OR 0.78; 95%CI, 0.61-0.99; p = 0.04) patients were less adherent to ACEI compared to Non-Asian patients. South Asian patients were more adherent to BBs (OR 1.3; 95%CI, 1.04-1.62; p = 0.02). There was no difference in prescribing of ACEI, nor adherence to statins among the ethnicities. CONCLUSION: Despite a higher likelihood of being prescribed evidence-based therapies following AMI, Chinese and South Asian patients were less likely to adhere to ACEI compared to their Non-Asian counterparts.
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Lai et al. (2011) conducted a cohort in Acute myocardial infarction (AMI) (n=9,926). Chinese ethnicity vs. Non-Asian ethnicity was evaluated on Adherence to ACE-inhibitors (proportion of days covered ≥ 80%) (OR 0.53, 95% CI 0.39-0.73, p=<0.0001). Elderly Chinese and South Asian AMI survivors were significantly less likely to adhere to ACE-inhibitors compared to Non-Asian patients (OR 0.53 and OR 0.78, respectively).
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