Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors.

Abstract

Background: Clinical guidelines recommend use of (1) antiplatelet, (2) lipid-lowering, and (3) beta blocker medication, and (4) angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEi/ARB) for secondary prevention following myocardial infarction (MI). This study examines whether sociodemographic factors and comorbidity were associated with receipt of guideline-recommended medication, and whether receipt was associated with all-cause mortality.

Methods: A cohort study was conducted on West of Scotland patients aged 53 years or above who were discharged from hospital alive after an incident MI between 2014 and 2022. Receipt of guideline-directed therapy was defined as relevant medications dispensed within 3 months of discharge. Age, sex, area-deprivation, care/nursing home residence, year of incident MI, and pre-existing conditions were included as predictors of non-receipt and covariates in the analysis of the association between non-receipt and death.

Results: Among 12,204 MI survivors, 7898 (64.72%) received all four classes of recommended medications. Non-receipt increased over the study period and was more likely in women, older people, more deprived people, care/nursing home residents, or those with preexisting atrial fibrillation, chronic kidney disease, liver diseases, chronic obstructive pulmonary disease, or psychosis; and was less likely in those who had prior revascularisation. Non-receipt was associated with higher mortality (HR 1.15, 95% CI 1.05-1.26) after adjusting for sociodemographic factors and preexisting conditions. Excess mortality due to area deprivation and care/nursing home residence could be partly explained by non-receipt of ACEi/ARB (9.4% for deprivation; 40.7% for care/nursing home residence) and lipid lowering medication (39.7% for care/nursing home residence).

Conclusions: Recommended secondary prevention medications were less likely to be received by women, those deprived, living in care/nursing homes, and with comorbid conditions. Equivalising appropriate ACEi/ARB use for secondary prevention could slightly reduce socioeconomic inequality of cardiovascular mortality.