Income‐Level and Immigrant Status Are Associated With Discontinuation of Evidence‐Based Secondary Prevention Therapies After Myocardial Infarction
Background Mechanisms for worse prognosis after myocardial infarction in low socioeconomic status are unclear. We therefore investigated the association between socioeconomic status and discontinuation of evidence‐based secondary prevention drug therapies. Methods All patients with a first‐ever myoc...
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2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.124.041781 |
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| author | Joel Ohm Kevin Ma Sara Freyland Ali Yari Tomas Jernberg Per Svensson |
| author_facet | Joel Ohm Kevin Ma Sara Freyland Ali Yari Tomas Jernberg Per Svensson |
| author_sort | Joel Ohm |
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| description | Background Mechanisms for worse prognosis after myocardial infarction in low socioeconomic status are unclear. We therefore investigated the association between socioeconomic status and discontinuation of evidence‐based secondary prevention drug therapies. Methods All patients with a first‐ever myocardial infarction, on treatment with a statin (n=60 717), antithrombotic therapy (n=65 862), or a renin‐angiotensin‐aldosterone‐system inhibitor (n=51 486) at the routine 1‐year visit in SWEDEHEART (Swedish Web‐System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) between January 2006 and mid‐2020 were included in this population‐based nationwide cohort study. Individual‐level socioeconomic status was measured by disposable income quintile, region of birth, and educational level. Outcomes were discontinuation (>180 days without a new prescription claim) of statins, antithrombotic therapies, and renin‐angiotensin‐aldosterone‐system‐inhibitors. Bias‐minimized multivariable adjusted hazard ratios (aHRs) were estimated during follow‐up until December 2020. Results Discontinuation occurred more often in the lowest versus highest income quintile for statins (aHR, 1.25 [95% CI, 1.20–1.31]), antithrombotic therapy (aHR, 1.26 [95% CI, 1.20–1.32]), and renin‐angiotensin‐aldosterone‐system inhibitors (aHR, 1.32 [95% CI, 1.26–1.39]). Discontinuation of statins was more frequent among immigrants (versus nonimmigrants) born in other Nordic (aHR, 1.24 [95% CI, 1.17–1.32]), other European (aHR, 1.40 [95% CI, 1.33–1.47]), Asian (aHR, 1.45 [95% CI, 1.36–1.56]), and other world regions (aHR, 1.63 [95% CI, 1.45–1.84]). Associations between immigrant background and discontinuation of antithrombotic therapies and renin‐angiotensin‐aldosterone‐system inhibitors were even stronger. Lower (versus tertiary) educational level was inversely associated with discontinuation of secondary prevention drug classes. Conclusions Despite Swedish universal health care, discontinuation of evidence‐based drugs post myocardial infarction is strongly associated with disposable income and immigrant background. Further study on strategies to improve adherence in low socioeconomic status post myocardial infarction is warranted. |
| format | Article |
| id | doaj-art-d43e693e2736410eae927973334d12ee |
| institution | Kabale University |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-d43e693e2736410eae927973334d12ee2025-08-20T03:34:45ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141310.1161/JAHA.124.041781Income‐Level and Immigrant Status Are Associated With Discontinuation of Evidence‐Based Secondary Prevention Therapies After Myocardial InfarctionJoel Ohm0Kevin Ma1Sara Freyland2Ali Yari3Tomas Jernberg4Per Svensson5Department of Medicine Solna Karolinska Institutet Stockholm SwedenDepartment of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm SwedenDivision of Biostatistics, Institute of Environmental Medicine Karolinska Institutet Stockholm SwedenDepartment of Clinical Sciences, Danderyd University Hospital Karolinska Institutet Stockholm SwedenDepartment of Clinical Sciences, Danderyd University Hospital Karolinska Institutet Stockholm SwedenDepartment of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm SwedenBackground Mechanisms for worse prognosis after myocardial infarction in low socioeconomic status are unclear. We therefore investigated the association between socioeconomic status and discontinuation of evidence‐based secondary prevention drug therapies. Methods All patients with a first‐ever myocardial infarction, on treatment with a statin (n=60 717), antithrombotic therapy (n=65 862), or a renin‐angiotensin‐aldosterone‐system inhibitor (n=51 486) at the routine 1‐year visit in SWEDEHEART (Swedish Web‐System for Enhancement and Development of Evidence‐Based Care in Heart Disease Evaluated According to Recommended Therapies) between January 2006 and mid‐2020 were included in this population‐based nationwide cohort study. Individual‐level socioeconomic status was measured by disposable income quintile, region of birth, and educational level. Outcomes were discontinuation (>180 days without a new prescription claim) of statins, antithrombotic therapies, and renin‐angiotensin‐aldosterone‐system‐inhibitors. Bias‐minimized multivariable adjusted hazard ratios (aHRs) were estimated during follow‐up until December 2020. Results Discontinuation occurred more often in the lowest versus highest income quintile for statins (aHR, 1.25 [95% CI, 1.20–1.31]), antithrombotic therapy (aHR, 1.26 [95% CI, 1.20–1.32]), and renin‐angiotensin‐aldosterone‐system inhibitors (aHR, 1.32 [95% CI, 1.26–1.39]). Discontinuation of statins was more frequent among immigrants (versus nonimmigrants) born in other Nordic (aHR, 1.24 [95% CI, 1.17–1.32]), other European (aHR, 1.40 [95% CI, 1.33–1.47]), Asian (aHR, 1.45 [95% CI, 1.36–1.56]), and other world regions (aHR, 1.63 [95% CI, 1.45–1.84]). Associations between immigrant background and discontinuation of antithrombotic therapies and renin‐angiotensin‐aldosterone‐system inhibitors were even stronger. Lower (versus tertiary) educational level was inversely associated with discontinuation of secondary prevention drug classes. Conclusions Despite Swedish universal health care, discontinuation of evidence‐based drugs post myocardial infarction is strongly associated with disposable income and immigrant background. Further study on strategies to improve adherence in low socioeconomic status post myocardial infarction is warranted.https://www.ahajournals.org/doi/10.1161/JAHA.124.041781cohort studiesmedication adherencemyocardial infarctionsecondary preventionsocioeconomic disparities in health |
| spellingShingle | Joel Ohm Kevin Ma Sara Freyland Ali Yari Tomas Jernberg Per Svensson Income‐Level and Immigrant Status Are Associated With Discontinuation of Evidence‐Based Secondary Prevention Therapies After Myocardial Infarction Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cohort studies medication adherence myocardial infarction secondary prevention socioeconomic disparities in health |
| title | Income‐Level and Immigrant Status Are Associated With Discontinuation of Evidence‐Based Secondary Prevention Therapies After Myocardial Infarction |
| title_full | Income‐Level and Immigrant Status Are Associated With Discontinuation of Evidence‐Based Secondary Prevention Therapies After Myocardial Infarction |
| title_fullStr | Income‐Level and Immigrant Status Are Associated With Discontinuation of Evidence‐Based Secondary Prevention Therapies After Myocardial Infarction |
| title_full_unstemmed | Income‐Level and Immigrant Status Are Associated With Discontinuation of Evidence‐Based Secondary Prevention Therapies After Myocardial Infarction |
| title_short | Income‐Level and Immigrant Status Are Associated With Discontinuation of Evidence‐Based Secondary Prevention Therapies After Myocardial Infarction |
| title_sort | income level and immigrant status are associated with discontinuation of evidence based secondary prevention therapies after myocardial infarction |
| topic | cohort studies medication adherence myocardial infarction secondary prevention socioeconomic disparities in health |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.041781 |
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