Education of Migrant and Nonmigrant Patients Is Associated With Initiation and Discontinuation of Preventive Medications for Acute Coronary Syndrome

Hanne Winther Frederiksen, Ann Dorthe Zwisler, Søren Paaske Johnsen, Buket Öztürk, Tove Lindhardt, Marie Norredam

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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.

Original languageEnglish
Article numbere009528
JournalJournal of the American Heart Association
Volume8
Issue number11
Number of pages9
ISSN2047-9980
DOIs
Publication statusPublished - 4. Jun 2019

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Patient Education
Acute Coronary Syndrome
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Medication Adherence
Education
Comorbidity

Keywords

  • acute coronary syndrome
  • ethnicity
  • medication discontinuance
  • patient education

Cite this

@article{44ed03769479482781b4bc778dee1b41,
title = "Education of Migrant and Nonmigrant Patients Is Associated With Initiation and Discontinuation of Preventive Medications for Acute Coronary Syndrome",
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.",
keywords = "acute coronary syndrome, ethnicity, medication discontinuance, patient education",
author = "Frederiksen, {Hanne Winther} and Zwisler, {Ann Dorthe} and Johnsen, {S{\o}ren Paaske} and Buket {\"O}zt{\"u}rk and Tove Lindhardt and Marie Norredam",
year = "2019",
month = "6",
day = "4",
doi = "10.1161/JAHA.118.009528",
language = "English",
volume = "8",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "11",

}

Education of Migrant and Nonmigrant Patients Is Associated With Initiation and Discontinuation of Preventive Medications for Acute Coronary Syndrome. / Frederiksen, Hanne Winther; Zwisler, Ann Dorthe; Johnsen, Søren Paaske; Öztürk, Buket; Lindhardt, Tove; Norredam, Marie.

In: Journal of the American Heart Association, Vol. 8, No. 11, e009528, 04.06.2019.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Education of Migrant and Nonmigrant Patients Is Associated With Initiation and Discontinuation of Preventive Medications for Acute Coronary Syndrome

AU - Frederiksen, Hanne Winther

AU - Zwisler, Ann Dorthe

AU - Johnsen, Søren Paaske

AU - Öztürk, Buket

AU - Lindhardt, Tove

AU - Norredam, Marie

PY - 2019/6/4

Y1 - 2019/6/4

N2 - 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.

AB - 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.

KW - acute coronary syndrome

KW - ethnicity

KW - medication discontinuance

KW - patient education

U2 - 10.1161/JAHA.118.009528

DO - 10.1161/JAHA.118.009528

M3 - Journal article

VL - 8

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 11

M1 - e009528

ER -