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Medicare Part D and Elimination of Cardiovascular Medication Usage Sociodemographic Disparities After Myocardial Infarction
In this issue of Circulation, Lauffenburger et al1 examine the effect of Medicare Part D implementation on statin, β-blocker, and angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blockers (ARBs) medication usage based on race/ethnicity and sex in the United States. The authors used Medicare service claims in 85 017 post-myocardial infarction (MI) patients aged ≥65 years. Their primary findings are that black women are 30% less likely to be adherent to ACEI/ARBs and statins at 1 year after MI compared with white men. Additionally, women and black/Hispanic men had 10% lower medication adherence rates compared with white men.
Article see p 754
In general, Asian men and women had similar medication adherence rates as white men, except for a 17% lower use of β-blockers in Asian women. These findings were noted despite similar rates of prescription usage at 30 days by race/ethnicity and sex 30 days after MI. The authors are to be commended for this effort and, in particular, the thoughtful discussion of their findings. Their manuscript is extremely important because only national, retrospective database information will capture background nationwide trends. Because the analyses incorporate 12-month medication usage before the index MI event, the analysis perhaps unintentionally takes into account pre-MI event medication factors that could affect post-MI adherence.
Nonetheless, some minor limitations of their manuscript are worthy of mention. First, as acknowledged by the authors, there is no information about aspirin use. Second, despite the “improvement” in accuracy of the Research Triangle Institute methodology to identify …