Paper: A descriptive analysis of medication adherence and mortality among elderly post-MI patients (2012 ACCP Annual Meeting)

Wednesday, October 24, 2012

Westin Diplomat Resort

Tasneem Lokhandwala, MS¹, Matthew Strum, PharmD, BCACP, CDE², Yi Yang, MD, PhD³, John Bentley, BS, MBA, PhD¹ and Benjamin Banahan III, PhD⁴
1University of Mississippi School of Pharmacy, University, MS
2Department of Pharmacy Practice, University of Mississippi School of Pharmacy, University, MS
3Department of Pharmacy Administration, University of Mississippi School of Pharmacy, University, MS
4Center for Pharmaceutical Marketing and Management, University of Mississippi School of Pharmacy, University, MS

Purpose: To provide a descriptive analysis of adherence to secondary prevention therapies and mortality among post myocardial infarction (MI) Medicare beneficiaries.

Methods: The 2006-2007 5% national sample of Medicare claims data were used. Beneficiaries ≥65 years old, hospitalized for acute MI between January 1 and December 31, 2006, were identified using a validated algorithm. Only those who survived for ≥90 days were included in analysis. Patients with ESRD and disabilities were excluded. Three classes of secondary prevention medications were examined: statins, beta-blockers, and ACEI/ARBs. Patients were classified as adherent if proportion of days covered during follow-up for a class of medication was ≥ 0.8.

Results: Of the 11,472 patients identified, 58.3% female, 87.7% white, 37.9% lived in the South, and 42.1% were 75-85 year olds. Among 5,036 statin users, 34.7% were adherent; a greater proportion of the non-adherent patients were from the South (38.4% vs. 36.5%; p=0.0069) compared to adherent patients. Among beta-blocker users (6,016), 38.9% were adherent; a higher proportion of the non-adherent patients were black (10.3% vs. 8.1%; p=0.0109) and from the Northeast (24.0% vs. 21.0%; p=0.0015) compared to adherent patients. Among 5,327 ACEI/ARBs users, 32.4% were adherent; non-adherent patients were more likely to be black (11.1% vs. 9.3%; p=0.0363) compared to adherent patients. Overall, 16.1% of patients died within a year. Across all three classes of medications, non-adherent patients were more likely to die within a year compared to adherent patients: statins (15.8 % vs. 1.8%; p<.0001), beta-blockers (20.9% vs. 2.4%; p<.0001), and ACEI/ARBs (18.9 % vs. 2.6%; p<.0001).

Conclusion: There are racial and geographic disparities in adherence to secondary prevention therapies among elderly post-MI patients and nonadherence is associated with a higher risk of mortality. Further research needs to identify predictors of such disparities and appropriate measures need to be designed to improve medication adherence.

183 A descriptive analysis of medication adherence and mortality among elderly post-MI patients