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Disability, Race Predictors of Medication Adherence Following a Heart Attack

Patients’ race and disability status make a significant difference in their compliance with a life-prolonging medication regimen in the year following a heart attack, according to new research led by Yuting Zhang, Ph.D., assistant professor of health economics, from the University of Pittsburgh Graduate School of Public Health.

The findings were published today in the September issue of the American Heart Journal.

African-Americans, followed by Native Americans, had the worst adherence to essential medications, including beta-blockers, statins, angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor blocker (ARB), one year after a heart attack. The racial difference in medication adherence is more pronounced among individuals with a disability. Even after adjusting for age, gender, income, drug coverage, location and health status, the racial difference in adherence persisted.

“Even among individuals with nearly full drug coverage, the difference in adherence rates between racial groups remains,” said Dr. Zhang. “This suggests that policies simply relying on cost reduction cannot eliminate racial disparities in medication adherence.”

Approximately 7.9 million Americans have had heart attacks, according to the American Heart Association. Clinical guidelines set by an American College of Cardiology and American Heart Association task force recommend all heart attack patients take a beta-blocker, a statin, aspirin, and either an ACE inhibitor or ARB for the remainder of their lives.

Dr. Zhang and her team analyzed 2008-2009 Medicare Part D data for 100 percent of Medicare fee-for-service beneficiaries discharged from the hospital after suffering a heart attack in 2008. They found that one-year medication adherence to beta-blockers in the United States was 68 percent for whites, 66 percent for Asians, 61 percent for Hispanics, 58 percent for Native Americans and 57 percent for African-Americans.

Among individuals with a disability, adherence rates were 59 percent for whites, 54 percent for Asians, 52 percent for Hispanics, 47 percent for Native Americans and 43 percent for African-Americans.

“Physicians should be aware of these differences in adherence as they treat patients,” Dr. Zhang said. “Long-term follow-up may be necessary to ensure that patients continue to use these important medications over time.”

In 1996, the National Committee for Quality Assurance (NCQA) began requiring health plans to provide performance measures of the drugs given after heart attacks. Following that requirement, the six-month adherence rate improved by more than 34 percent, indicating that such policies could be beneficial in improving long-term adherence rates, Dr. Zhang said.

Co-authors include Seo Hyon Baik, Ph.D., Cameron M. Kaplan, Ph.D., and Judith R. Lave, Ph.D., all of Pitt Public Health’s Department of Health Policy and Management; and Chung-Chou H. Chang, Ph.D., of the University of Pittsburgh School of Medicine.


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