Association of Patient Enrollment in Medicare Part D with Outcomes after Acute Myocardial Infarction

Abhinav Goyal, James A de Lemos, S. Andrew Peng, Laine Thomas, Ezra A. Amsterdam, Jason M. Hockenberry, Eric D. Peterson, Tracy Y. Wang

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

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). Methods and 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.

Original languageEnglish (US)
Pages (from-to)567-575
Number of pages9
JournalCirculation: Cardiovascular Quality and Outcomes
Volume8
Issue number6
DOIs
StatePublished - Dec 1 2015

Fingerprint

Medicare Part D
Medicare
Myocardial Infarction
Social Adjustment
Prescription Drugs
Angiotensin Receptor Antagonists
Cause of Death
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Medication Adherence
Secondary Prevention
Angiotensin-Converting Enzyme Inhibitors
Registries
Stroke
Guidelines
Confidence Intervals
Mortality

Keywords

  • Medicare Part D
  • myocardial infarction
  • Registries
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Association of Patient Enrollment in Medicare Part D with Outcomes after Acute Myocardial Infarction. / Goyal, Abhinav; de Lemos, James A; Peng, S. Andrew; Thomas, Laine; Amsterdam, Ezra A.; Hockenberry, Jason M.; Peterson, Eric D.; Wang, Tracy Y.

In: Circulation: Cardiovascular Quality and Outcomes, Vol. 8, No. 6, 01.12.2015, p. 567-575.

Research output: Contribution to journalArticle

Goyal, Abhinav ; de Lemos, James A ; Peng, S. Andrew ; Thomas, Laine ; Amsterdam, Ezra A. ; Hockenberry, Jason M. ; Peterson, Eric D. ; Wang, Tracy Y. / Association of Patient Enrollment in Medicare Part D with Outcomes after Acute Myocardial Infarction. In: Circulation: Cardiovascular Quality and Outcomes. 2015 ; Vol. 8, No. 6. pp. 567-575.
@article{9e22169fdc1043e894354965279c8080,
title = "Association of Patient Enrollment in Medicare Part D with Outcomes after Acute Myocardial Infarction",
abstract = "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). Methods and 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.",
keywords = "Medicare Part D, myocardial infarction, Registries, stroke",
author = "Abhinav Goyal and {de Lemos}, {James A} and Peng, {S. Andrew} and Laine Thomas and Amsterdam, {Ezra A.} and Hockenberry, {Jason M.} and Peterson, {Eric D.} and Wang, {Tracy Y.}",
year = "2015",
month = "12",
day = "1",
doi = "10.1161/CIRCOUTCOMES.115.001650",
language = "English (US)",
volume = "8",
pages = "567--575",
journal = "Circulation: Cardiovascular Quality and Outcomes",
issn = "1941-7713",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - Association of Patient Enrollment in Medicare Part D with Outcomes after Acute Myocardial Infarction

AU - Goyal, Abhinav

AU - de Lemos, James A

AU - Peng, S. Andrew

AU - Thomas, Laine

AU - Amsterdam, Ezra A.

AU - Hockenberry, Jason M.

AU - Peterson, Eric D.

AU - Wang, Tracy Y.

PY - 2015/12/1

Y1 - 2015/12/1

N2 - 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). Methods and 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.

AB - 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). Methods and 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.

KW - Medicare Part D

KW - myocardial infarction

KW - Registries

KW - stroke

UR - http://www.scopus.com/inward/record.url?scp=84947723896&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84947723896&partnerID=8YFLogxK

U2 - 10.1161/CIRCOUTCOMES.115.001650

DO - 10.1161/CIRCOUTCOMES.115.001650

M3 - Article

C2 - 26508667

AN - SCOPUS:84947723896

VL - 8

SP - 567

EP - 575

JO - Circulation: Cardiovascular Quality and Outcomes

JF - Circulation: Cardiovascular Quality and Outcomes

SN - 1941-7713

IS - 6

ER -