Is remoteness associated with receipt of and adherence to secondary prevention medications post STEMI? A Victorian linked cohort study.

Abstract

Background: People in rural and remote areas may have poorer cardiovascular outcomes than people in metropolitan areas. The objective of this study was to analyse differences in receiving and adhering to secondary prevention medications following ST elevation myocardial infarction (STEMI) by remoteness in Victoria. Method: All individuals discharged between 1 July 2012 and 30 June 2017 and alive at 90 days post-discharge were identified through the Victorian Admitted Episodes Dataset (n=12,015). Receipt (within 90 days) and 12-month adherence (defined as ≥80% proportion of days covered) to beta-blockers (BB), ACE inhibitors or angiotensin receptor blockers (ACEI/ARB), P2Y12 inhibitors (P2Y12i) and statins were estimated via linkage to the Pharmaceutical Benefits Scheme. Remoteness was quantified using the Accessibility/Remoteness Index of Australia (ARIA). Adjusted odds ratios (OR) and 95% confidence intervals (CIs) for receipt and adherence were estimated using logistic regression. Results: Following STEMI, 69% of people received BB, 77% ACEI/ARB, 75% P2Y12i and 80% statins. For each one-unit increase in ARIA score, ORs were 0.98 (95%CI 0.92–1.03) for receipt of BB, 1.00 (95%CI 0.94–1.08) for ACEI/ARB, 0.91 (95%CI 0.83–0.98) for P2Y12i and 1.06 (95%CI 0.96–1.18) for statins. For each one-unit increase in ARIA score, ORs for 12-month adherence were 1.04 (95%CI 0.98–1.10) for BB, 1.15 (95%CI 1.09–1.22) for ACEI/ARB, 1.16 (95%CI 1.09–1.24) for P2Y12i, and 1.14 (95%CI 1.08-1.21) for statins. Conclusion: Remoteness does not appear to affect initial dispensing of secondary prevention medications within 90 days post-STEMI. Remoteness is not a driver of non-adherence if patients are dispensed initial secondary prevention therapy.