Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study
Background In Canada, First Nations (FN) people are at greater risk of mortality than the general population following index angiography. This disparity has not been investigated while considering guideline‐recommended cardiovascular medication use. Methods and Results Retrospective analysis of admi...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2019-08-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.119.012040 |
| _version_ | 1818775603132760064 |
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| author | Lindsey Dahl Annette Schultz Elizabeth McGibbon Jarvis Brownlie Catherine Cook Basem Elbarouni Alan Katz Thang Nguyen Jo Ann Sawatzky Moneca Sinclaire Karen Throndson Heather J. Prior Randy Fransoo |
| author_facet | Lindsey Dahl Annette Schultz Elizabeth McGibbon Jarvis Brownlie Catherine Cook Basem Elbarouni Alan Katz Thang Nguyen Jo Ann Sawatzky Moneca Sinclaire Karen Throndson Heather J. Prior Randy Fransoo |
| author_sort | Lindsey Dahl |
| collection | DOAJ |
| description | Background In Canada, First Nations (FN) people are at greater risk of mortality than the general population following index angiography. This disparity has not been investigated while considering guideline‐recommended cardiovascular medication use. Methods and Results Retrospective analysis of administrative health data investigated patterns of medication dispensation during the first year after index angiography among patients in Manitoba, Canada. Medication possession ratios (MPRs) reflecting the percentage of days in which medications were supplied were calculated separately for β‐blockers, angiotensin‐converting enzyme inhibitors, statins, and antiplatelets (clopidogrel). Patients were assigned to 1 of 4 categories: (1) not dispensed (0% MPR), (2) low (1–39% MPR), (3) intermediate (40–79% MPR), (4) high (≥80% MPR). Cox regression models that adjusted for MPR categories were used to explore the association between FN patients and both 5‐year all‐cause mortality and cardiovascular mortality. FN patients were less likely to have an intermediate MPR (odds ratio: 0.75; 95% CI, 0.57–0.99) or a high MPR (odds ratio: 0.64; 95% CI, 0.50–0.81) for statin medications than non‐FN patients. FN patients also had higher adjusted risks of all‐cause and cardiovascular mortality than non‐FN patients (hazard ratio, all‐cause: 1.54 [95% CI, 1.25–1.89]; cardiovascular: 1.62 [95% CI, 1.16–2.25]). Conclusions FN status was independently associated with intermediate and high MPRs for statins during the first year following index angiography among patients with known ischemic heart disease. Differences in MPR categories did not explain the disparity in all‐cause and cardiovascular mortality between the 2 populations. Reduction of cardiovascular disparities may be best addressed using primary prevention strategies that include decolonizing policies and practices. |
| first_indexed | 2024-12-18T10:59:39Z |
| format | Article |
| id | doaj.art-dbd38e3034424c08b1fe3fa226a5a814 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-12-18T10:59:39Z |
| publishDate | 2019-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-dbd38e3034424c08b1fe3fa226a5a8142022-12-21T21:10:15ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802019-08-0181610.1161/JAHA.119.012040Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort StudyLindsey Dahl0Annette Schultz1Elizabeth McGibbon2Jarvis Brownlie3Catherine Cook4Basem Elbarouni5Alan Katz6Thang Nguyen7Jo Ann Sawatzky8Moneca Sinclaire9Karen Throndson10Heather J. Prior11Randy Fransoo12Rady Faculty of Health Sciences University of Manitoba Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaFaculty of Health Sciences St. Francis Xavier University Antigonish CanadaFaculty of Arts University of Manitoba Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaSt. Boniface General Hospital Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaRady Faculty of Health Sciences University of Manitoba Winnipeg CanadaBackground In Canada, First Nations (FN) people are at greater risk of mortality than the general population following index angiography. This disparity has not been investigated while considering guideline‐recommended cardiovascular medication use. Methods and Results Retrospective analysis of administrative health data investigated patterns of medication dispensation during the first year after index angiography among patients in Manitoba, Canada. Medication possession ratios (MPRs) reflecting the percentage of days in which medications were supplied were calculated separately for β‐blockers, angiotensin‐converting enzyme inhibitors, statins, and antiplatelets (clopidogrel). Patients were assigned to 1 of 4 categories: (1) not dispensed (0% MPR), (2) low (1–39% MPR), (3) intermediate (40–79% MPR), (4) high (≥80% MPR). Cox regression models that adjusted for MPR categories were used to explore the association between FN patients and both 5‐year all‐cause mortality and cardiovascular mortality. FN patients were less likely to have an intermediate MPR (odds ratio: 0.75; 95% CI, 0.57–0.99) or a high MPR (odds ratio: 0.64; 95% CI, 0.50–0.81) for statin medications than non‐FN patients. FN patients also had higher adjusted risks of all‐cause and cardiovascular mortality than non‐FN patients (hazard ratio, all‐cause: 1.54 [95% CI, 1.25–1.89]; cardiovascular: 1.62 [95% CI, 1.16–2.25]). Conclusions FN status was independently associated with intermediate and high MPRs for statins during the first year following index angiography among patients with known ischemic heart disease. Differences in MPR categories did not explain the disparity in all‐cause and cardiovascular mortality between the 2 populations. Reduction of cardiovascular disparities may be best addressed using primary prevention strategies that include decolonizing policies and practices.https://www.ahajournals.org/doi/10.1161/JAHA.119.012040angiographydisparitiesmedication adherenceoutcomes researchpopulation studies |
| spellingShingle | Lindsey Dahl Annette Schultz Elizabeth McGibbon Jarvis Brownlie Catherine Cook Basem Elbarouni Alan Katz Thang Nguyen Jo Ann Sawatzky Moneca Sinclaire Karen Throndson Heather J. Prior Randy Fransoo Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease angiography disparities medication adherence outcomes research population studies |
| title | Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study |
| title_full | Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study |
| title_fullStr | Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study |
| title_full_unstemmed | Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study |
| title_short | Cardiovascular Medication Use and Long‐Term Outcomes of First Nations and Non–First Nations Patients Following Diagnostic Angiography: A Retrospective Cohort Study |
| title_sort | cardiovascular medication use and long term outcomes of first nations and non first nations patients following diagnostic angiography a retrospective cohort study |
| topic | angiography disparities medication adherence outcomes research population studies |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.119.012040 |
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