1.4-O5
Large differences in uptake of secondary prevention after acute coronary syndrome among migrants compared to Danish-born Free

Background:

There is evidence that patients discharged after acute coronary syndrome (ACS) benefit from secondary prevention measures, including preventive medications, physical exercise, dietary advice and patient education. In general populations, uptake of the measures have been found to be low, but migrants are grossly underrepresented in previous European studies. Furthermore, migrants are at risk of experiencing access barriers related to language, culture and knowledge. Therefore, the aim of this study is to assess the use of preventive medications, physical exercise, dietary advice and patient education after ACS among migrants to Denmark compared to the local-born population.

Methods:

We selected the population (N = 33,199) from nationwide registers, and followed subjects for a maximum of five years post-ACS. We assessed the initiation and risk of discontinuation of preventive medications, and the initiation and number of contacts for physical exercise, dietary advice and patient education, and adjusted for comorbidity, sociodemographic factors and university-affiliated hospitals.

Results:

Non-Western migrants were less likely to initiate ADP- and ACE-inhibitors (0.78, CI: 0.69; 0.88, and 0.79, CI: 0.71; 0.89) and patient education (0.83, CI: 0.74; 0.94). Furthermore, non-Western migrants had a higher risk of discontinuing medications (Statins: 1.64, CI: 1.45; 1.86, ADP-inhibitors: 1.72, CI: 1.50; 1.97, β-blockers: 1.52, CI: 1.40; 1.64, and ACE-inhibitors: 1.72, CI: 1.46; 2.02), and had fewer contacts for physical exercise and patient education (p < 0.001 and p = 0.011).

Conclusion:

Non-Western migrants had significantly lower use of medications. Differences in use of non-pharmacological interventions were statistically significant but less pronounced. Comorbidity, sociodemographic factors and hospital characteristics did not explain the findings.

Main messages:

Migrants’ use of preventive medications, physical exercise and patient education post-ACS is lower than local-borns’. Differences could not be explained by comorbidity, sociodemographic factors or characteristics of hospitals, indicating the existence of migrant-specific barriers at the individual or system levels.