Journal of the American Heart Association
Volume 8, Issue 11, 2019

Education of Migrant and Nonmigrant Patients Is Associated With Initiation and Discontinuation of Preventive Medications for Acute Coronary Syndrome (Article) (Open Access)

Frederiksen H.W.* , Zwisler A.-D. , Johnsen S.P. , Öztürk B. , Lindhardt T. , Norredam M.
  • a Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark, Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark, Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark
  • b Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense, Denmark
  • c Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  • d Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
  • e Department of Internal Medicine, Copenhagen University Hospital, Herlev, Denmark
  • f Danish Research Centre for Migration, Ethnicity and Health, University of Copenhagen, Copenhagen, Denmark, Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, Hvidovre, Denmark

Abstract

Background: The benefits of preventive medications after acute coronary syndrome are impeded by low medication persistence, in particular among marginalized patient groups. Patient education might increase medication persistence, but the effect is still uncertain, especially among migrant groups. We, therefore, assessed whether use of patient education was associated with medication persistence after acute coronary syndrome and whether migrant background modified the potential associations. Methods and Results: A cohort of patients discharged with a diagnosis of acute coronary syndrome (N=33 199) was identified in national registers. We then assessed number of contacts for patient education during a period of 6 months after discharge and the initiation and discontinuation of preventive medications during a period of up to 5 years. Results were adjusted for comorbidity and sociodemographic factors. Three or more contacts for patient education was associated with a higher likelihood of initiating preventive medications, corresponding to adjusted relative risks ranging from 1.12 (95% CI, 1.06–1.18) for statins to 1.39 (95% CI, 1.28–1.51) for ADP inhibitors. Lower risks of subsequent discontinuation were also observed, with adjusted hazard ratios ranging from 0.86 (95% CI, 0.79–0.92) for statins to 0.92 (95% CI, 0.88–0.97) for β blockers. Stratification and test for effect modification by migrant status showed insignificant effect modification, except for initiation of ADP inhibitors and statins. Conclusions: Patient education is associated with higher chance of initiating preventive medications after acute coronary syndrome and a lower long-term risk of subsequent discontinuation independently of migrant status. © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Author Keywords

medication discontinuance patient education Ethnicity acute coronary syndrome

Index Keywords

beta adrenergic receptor blocking agent human risk assessment priority journal Aged medication compliance migrant male female patient education adenosine receptor blocking agent Article hydroxymethylglutaryl coenzyme A reductase inhibitor dipeptidyl carboxypeptidase inhibitor patient compliance major clinical study adult acute coronary syndrome preventive medicine cohort analysis ethnicity treatment withdrawal
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85067310319&doi=10.1161%2fJAHA.118.009528&partnerID=40&md5=9f4018e31606f652dd878e112f2bc29b
DOI: 10.1161/JAHA.118.009528
ISSN: 20479980
Original Language: English