title: Sex Disparities in Post-Acute Myocardial Infarction Pharmacologic Treatment Initiation and Adherence: Problem for Young Women.
abstract: BACKGROUND
  The prevalence of the use of secondary prevention cardiovascular medications is lower among women than men, but it is unclear if this is a result of lower treatment initiation among women or lower treatment adherence. We aimed to map the treatment pathway for survivors of acute myocardial infarction (AMI) by sex and age.
  
  
  RESULTS
  This retrospective population-based cohort study used linked administrative data sets in British Columbia (2004-2011), which include health care, prescription drugs, sociodemographic, and mortality information. The study cohort included all individuals admitted to hospital for AMI in 2007-2009 and survived for 1 year after hospital discharge. Patients were evaluated for whether they initiated and then subsequently filled prescriptions angiotensin-converting enzyme inhibitors, β-blockers, and statins. More than two thirds of AMI survivors initiated treatment on all appropriate medications, given their contraindications, within 2 months of discharge. Younger men were significantly more likely than younger women to initiate appropriate treatment (adjusted odds ratio, 1.38; 95% confidence interval, 1.10-1.75). By the end of 1 year after discharge, only one third of all AMI survivors filled all appropriate prescriptions for at least 80% of the year. There was no significant difference in adherence to medication therapy between women and men.
  
  
  CONCLUSIONS
  The majority of AMI survivors either discontinue treatment or do not refill their prescriptions consistently. Women <55 years are significantly less likely to be on optimal therapy by the end of 1 year after discharge, which is driven by a sex disparity in treatment initiation and not treatment adherence.
authors.affiliation: From the Centre for Health Services and Policy Research, School of Population and Public Health (K.S., L.B., S.G.M.), Division of Cardiology (K.H.H.), and Division of General Internal Medicine (N.K.), University of British Columbia, Vancouver, British Columbia, Canada. kate.smolina@ubc.ca.
authors.forename: Kate
authors.initials: K
authors.lastname: Smolina
authors.affiliation: From the Centre for Health Services and Policy Research, School of Population and Public Health (K.S., L.B., S.G.M.), Division of Cardiology (K.H.H.), and Division of General Internal Medicine (N.K.), University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Laura
authors.initials: L
authors.lastname: Ball
authors.affiliation: From the Centre for Health Services and Policy Research, School of Population and Public Health (K.S., L.B., S.G.M.), Division of Cardiology (K.H.H.), and Division of General Internal Medicine (N.K.), University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Karin H
authors.initials: KH
authors.lastname: Humphries
authors.affiliation: From the Centre for Health Services and Policy Research, School of Population and Public Health (K.S., L.B., S.G.M.), Division of Cardiology (K.H.H.), and Division of General Internal Medicine (N.K.), University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Nadia
authors.initials: N
authors.lastname: Khan
authors.affiliation: From the Centre for Health Services and Policy Research, School of Population and Public Health (K.S., L.B., S.G.M.), Division of Cardiology (K.H.H.), and Division of General Internal Medicine (N.K.), University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Steven G
authors.initials: SG
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D011307:Drug Prescriptions; D017723:Drug Utilization Review; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054625:Healthcare Disparities; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention / Q000379:methods*; D012737:Sex Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D002317:Cardiovascular Agents
keywords: cohort studies; myocardial infarction; odds ratio; prevalence; survivors