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Medicare Part D does not impact patient outcomes after heart attack, study shows

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Jennifer Johnson McEwen
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An Emory University study shows that for patients who experience a heart attack, or acute myocardial infarction (MI), enrollment in Part D by hospital discharge is not associated with improved outcomes. Findings were recently published in Circulation: Cardiovascular Quality and Outcomes.

Medicare Part D was created in 2006 to give Medicare enrollees an option to purchase a subsidized prescription drug plan to help cover the costs of outpatient medications.

Lead researcher Abhinav Goyal, MD, associate professor of medicine (cardiology) at Emory University School of Medicine and his colleagues looked at trends in Medicare Part D enrollment among 59,149 Medicare patients with acute MI. The patients were treated at 502 hospitals and discharged between January 2007 and December 2010.

The researchers compared 30-day and one-year outcomes (all-cause death, all-cause readmissions and major adverse cardiac events) among Part D enrollees (49.5 percent) and non-enrollees.

"Our analysis showed that only half of Medicare-insured patients with acute MI were enrolled in Part D by hospital discharge, and their 30-day and one-year adjusted outcomes did not differ substantially from those not enrolled in Part D coverage," says Goyal. 

At 30 days after discharge, the all-cause death rates were 4 percent in patients enrolled in Part D and 3.3 percent in patients who were not enrolled, although the difference was not statistically significant.

Patients with Part D coverage also had higher risks of 30-day all cause readmissions or major cardiac events, but as researchers noted, after adjusting for multiple variables, the differences were not significant.

The study also showed that only 55 percent to 64 percent of patients enrolled in Part D were regularly taking their medications one year after their acute MI and, as the study points out, "there remain opportunities for improvement in medication adherence among patient with prescription drug coverage." 

Physicians usually prescribe statins, beta-blockers, ACE inhibitors and other medications following a MI.

 "Many people think that being enrolled in Part D might improve your rate of taking prescription medications that are proven to help protect against future events after a heart attack," says Goyal.

"But what we found is that people enrolled in Part D have a relatively poor adherence to these medications through one year. This might help explain why it didn’t translate into better outcomes compared with those not in Part D."

Goyal says patients with Part D coverage were more likely to have previous MI, heart failure, stroke and peripheral arterial disease and other comorbid conditions such as hypertension, dialysis, chronic lung disease and diabetes. They were also more likely to have been hospitalized within the previous 12 months.

To see the full Circulation article, please click here.   

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