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Open Access Highly Accessed Research article

Cardiac medication prescribing and adherence after acute myocardial infarction in Chinese and South Asian Canadian patients

Emily J Lai1*, Maja Grubisic2, Anita Palepu1, Hude Quan3, Kathryn M King3 and Nadia A Khan1

Author Affiliations

1 Department of Medicine, University of British Columbia, 10th floor - 2775rel S Laut., Vancouver, BC V5Z 1M9, Canada

2 Center for Health Evaluation and Outcomes Sciences, St. Paul's Hospital, 620B - 1081 Burrard St., Vancouver, BC V6Z 1Y6, Canada

3 Department of Community Health Sciences, University of Calgary, TRW Bldg 3rd floor - 3280 Hospital Dr NW, Calgary, AB T2N 4Z6, Canada

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BMC Cardiovascular Disorders 2011, 11:56  doi:10.1186/1471-2261-11-56

Published: 18 September 2011

Abstract

Background

Failure to adhere to cardiac medications after acute myocardial infarction (AMI) is associated with increased mortality. Language barriers and preference for traditional medications may predispose certain ethnic groups at high risk for non-adherence. We compared prescribing and adherence to ACE-inhibitors (ACEI), beta-blockers (BB), and statins following AMI among elderly Chinese, South Asian, and Non-Asian patients.

Methods

Retrospective-cohort study of elderly AMI survivors (1995-2002) using administrative data from British Columbia. AMI cases and ethnicity were identified using validated ICD-9/10 coding and surname algorithms, respectively. Medication adherence was assessed using the 'proportion of days covered' (PDC) metric with a PDC ≥ 0.80 indicating optimal adherence. The independent effect of ethnicity on adherence was assessed using multivariable modeling, adjusting for socio-demographic and clinical characteristics.

Results

There were 9926 elderly AMI survivors (258 Chinese, 511 South Asian patients). More Chinese patients were prescribed BBs (79.7% vs. 73.1%, p = 0.04) and more South Asian patients were prescribed statins (73.5% vs. 65.2%, p = 0.001). Both Chinese (Odds Ratio [OR] 0.53; 95%CI, 0.39-0.73; p < 0.0001) and South Asian (OR 0.78; 95%CI, 0.61-0.99; p = 0.04) patients were less adherent to ACEI compared to Non-Asian patients. South Asian patients were more adherent to BBs (OR 1.3; 95%CI, 1.04-1.62; p = 0.02). There was no difference in prescribing of ACEI, nor adherence to statins among the ethnicities.

Conclusion

Despite a higher likelihood of being prescribed evidence-based therapies following AMI, Chinese and South Asian patients were less likely to adhere to ACEI compared to their Non-Asian counterparts.

Keywords:
medication adherence; acute myocardial infarction; ethnicity