Association of Patient Enrollment in Medicare Part D With Outcomes After Acute Myocardial Infarction.
BACKGROUND
Little is known about whether enrollment versus nonenrollment in Medicare's prescription drug plan (Part D) is associated with better outcomes after acute myocardial infarction (AMI).


RESULTS
Using Medicare records linked to Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines, we identified 59 149 Medicare beneficiaries (age ≥65 years) discharged after AMI between January 2007 and December 2010. We described trends in Medicare Part D enrollment, and compared the following 30-day and 1-year outcomes: all-cause death, all-cause readmissions, and major adverse cardiac events (a composite of all-cause death or readmission for AMI or stroke) between Part D enrollees and nonenrollees, after adjustment for patient and hospital factors. From 2007 to 2010, 29 264 (49.5%) patients with AMI enrolled in Medicare were also participating in Part D by hospital discharge. All-cause 30-day death was more common among enrollees versus nonenrollees (4.0% versus 3.3%), but this difference was not statistically significant after multivariable adjustment (adjusted hazard ratio, 1.06 [95% confidence interval, 0.97-1.17]). Enrollees also had higher unadjusted risks of 30-day all-cause readmissions or major adverse cardiac events, and 1-year mortality, all-cause readmissions, or major adverse cardiac events, but these were attenuated after multivariable adjustment. Adherence to key secondary prevention medications (statins, β-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and P2Y12 antagonists) remained low (range, 55%-64%) at 1 year post discharge among Part D enrollees.


CONCLUSIONS
Only half of Medicare-insured patients with AMI were enrolled in Part D by hospital discharge, and their 30-day and 1-year adjusted outcomes did not differ substantially from nonenrollees. There remain opportunities for improvement in medication adherence among patients with prescription drug coverage.
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.G.); Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX (J.A.d.L.); Department of Biostatistics and Bioinformatics (L.T) and Department of Medicine (E.D.P., T.Y.W.), Duke Clinical Research Institute, Durham, NC (S.A.P.); Department of Internal Medicine, University of California, Davis Medical Center, Sacramento (E.A.A.); Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, GA (J.M.H.); and Department of Medicine, Duke University Medical School, Durham, NC (E.D.P., T.Y.W.). agoyal4@emory.edu.
Abhinav
A
Goyal
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.G.); Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX (J.A.d.L.); Department of Biostatistics and Bioinformatics (L.T) and Department of Medicine (E.D.P., T.Y.W.), Duke Clinical Research Institute, Durham, NC (S.A.P.); Department of Internal Medicine, University of California, Davis Medical Center, Sacramento (E.A.A.); Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, GA (J.M.H.); and Department of Medicine, Duke University Medical School, Durham, NC (E.D.P., T.Y.W.).
James A
JA
de Lemos
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.G.); Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX (J.A.d.L.); Department of Biostatistics and Bioinformatics (L.T) and Department of Medicine (E.D.P., T.Y.W.), Duke Clinical Research Institute, Durham, NC (S.A.P.); Department of Internal Medicine, University of California, Davis Medical Center, Sacramento (E.A.A.); Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, GA (J.M.H.); and Department of Medicine, Duke University Medical School, Durham, NC (E.D.P., T.Y.W.).
S Andrew
SA
Peng
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.G.); Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX (J.A.d.L.); Department of Biostatistics and Bioinformatics (L.T) and Department of Medicine (E.D.P., T.Y.W.), Duke Clinical Research Institute, Durham, NC (S.A.P.); Department of Internal Medicine, University of California, Davis Medical Center, Sacramento (E.A.A.); Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, GA (J.M.H.); and Department of Medicine, Duke University Medical School, Durham, NC (E.D.P., T.Y.W.).
Laine
L
Thomas
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.G.); Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX (J.A.d.L.); Department of Biostatistics and Bioinformatics (L.T) and Department of Medicine (E.D.P., T.Y.W.), Duke Clinical Research Institute, Durham, NC (S.A.P.); Department of Internal Medicine, University of California, Davis Medical Center, Sacramento (E.A.A.); Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, GA (J.M.H.); and Department of Medicine, Duke University Medical School, Durham, NC (E.D.P., T.Y.W.).
Ezra A
EA
Amsterdam
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.G.); Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX (J.A.d.L.); Department of Biostatistics and Bioinformatics (L.T) and Department of Medicine (E.D.P., T.Y.W.), Duke Clinical Research Institute, Durham, NC (S.A.P.); Department of Internal Medicine, University of California, Davis Medical Center, Sacramento (E.A.A.); Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, GA (J.M.H.); and Department of Medicine, Duke University Medical School, Durham, NC (E.D.P., T.Y.W.).
Jason M
JM
Hockenberry
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.G.); Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX (J.A.d.L.); Department of Biostatistics and Bioinformatics (L.T) and Department of Medicine (E.D.P., T.Y.W.), Duke Clinical Research Institute, Durham, NC (S.A.P.); Department of Internal Medicine, University of California, Davis Medical Center, Sacramento (E.A.A.); Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, GA (J.M.H.); and Department of Medicine, Duke University Medical School, Durham, NC (E.D.P., T.Y.W.).
Eric D
ED
Peterson
From the Department of Medicine, Emory University School of Medicine, Atlanta, GA (A.G.); Department of Internal Medicine, UT Southwestern Medical School, Dallas, TX (J.A.d.L.); Department of Biostatistics and Bioinformatics (L.T) and Department of Medicine (E.D.P., T.Y.W.), Duke Clinical Research Institute, Durham, NC (S.A.P.); Department of Internal Medicine, University of California, Davis Medical Center, Sacramento (E.A.A.); Department of Health Policy and Management, Emory Rollins School of Public Health, Atlanta, GA (J.M.H.); and Department of Medicine, Duke University Medical School, Durham, NC (E.D.P., T.Y.W.).
Tracy Y
TY
Wang
D000368:Aged; D000369:Aged, 80 and over; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D057286:Electronic Health Records; D005260:Female; D006801:Humans; D007342:Insurance Benefits; D008297:Male; D008498:Medical Record Linkage; D054524:Medicare Part D; D055118:Medication Adherence; D009203:Myocardial Infarction / Q000175:diagnosis / Q000188:drug therapy* / Q000401:mortality; D010351:Patient Discharge; D010359:Patient Readmission; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D002317:Cardiovascular Agents
Medicare Part D; Registries; myocardial infarction; stroke