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 examine...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12916-025-04160-5 |
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| author | Ike Dhiah Rochmawati Jocelyn M. Friday Daniel Ang Tran Q. B. Tran Clea du Toit Alan Stevenson Jim Lewsey Daniel Mackay Ruth Dundas Bhautesh Jani S. Vittal Katikireddi Christian Delles Sandosh Padmanabhan Carlos Celis-Morales Paul Welsh Frederick K. Ho Jill P. Pell |
| author_facet | Ike Dhiah Rochmawati Jocelyn M. Friday Daniel Ang Tran Q. B. Tran Clea du Toit Alan Stevenson Jim Lewsey Daniel Mackay Ruth Dundas Bhautesh Jani S. Vittal Katikireddi Christian Delles Sandosh Padmanabhan Carlos Celis-Morales Paul Welsh Frederick K. Ho Jill P. Pell |
| author_sort | Ike Dhiah Rochmawati |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-12e7be954c8f40278955cc338cf7eba8 |
| institution | DOAJ |
| issn | 1741-7015 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Medicine |
| spelling | doaj-art-12e7be954c8f40278955cc338cf7eba82025-08-20T03:03:28ZengBMCBMC Medicine1741-70152025-07-0123111110.1186/s12916-025-04160-5Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivorsIke Dhiah Rochmawati0Jocelyn M. Friday1Daniel Ang2Tran Q. B. Tran3Clea du Toit4Alan Stevenson5Jim Lewsey6Daniel Mackay7Ruth Dundas8Bhautesh Jani9S. Vittal Katikireddi10Christian Delles11Sandosh Padmanabhan12Carlos Celis-Morales13Paul Welsh14Frederick K. Ho15Jill P. Pell16School of Health and Wellbeing, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Health and Wellbeing, University of GlasgowSchool of Health and Wellbeing, University of GlasgowSchool of Health and Wellbeing, University of GlasgowSchool of Health and Wellbeing, University of GlasgowSchool of Health and Wellbeing, University of GlasgowSchool of Health and Wellbeing, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Cardiovascular and Metabolic Health, University of GlasgowSchool of Health and Wellbeing, University of GlasgowSchool of Health and Wellbeing, University of GlasgowAbstract 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.https://doi.org/10.1186/s12916-025-04160-5Myocardial infarctionMedicationComorbiditySociodemographic |
| spellingShingle | Ike Dhiah Rochmawati Jocelyn M. Friday Daniel Ang Tran Q. B. Tran Clea du Toit Alan Stevenson Jim Lewsey Daniel Mackay Ruth Dundas Bhautesh Jani S. Vittal Katikireddi Christian Delles Sandosh Padmanabhan Carlos Celis-Morales Paul Welsh Frederick K. Ho Jill P. Pell Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors BMC Medicine Myocardial infarction Medication Comorbidity Sociodemographic |
| title | Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors |
| title_full | Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors |
| title_fullStr | Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors |
| title_full_unstemmed | Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors |
| title_short | Association of sociodemographic factors and comorbidity with non-receipt of medications for secondary prevention: a cohort study of 12,204 myocardial infarction survivors |
| title_sort | association of sociodemographic factors and comorbidity with non receipt of medications for secondary prevention a cohort study of 12 204 myocardial infarction survivors |
| topic | Myocardial infarction Medication Comorbidity Sociodemographic |
| url | https://doi.org/10.1186/s12916-025-04160-5 |
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