You don’t need to be a doctor to know taking medication as prescribed can save your life, especially when you have a chronic health condition like heart disease. Affecting about 47% of Black adults, the condition causes fatigue and may lead to severe mental and emotional distress.
But a team of researchers at New York University’s (NYU) Grossman School of Medicine found a staggering gap in heart medication adherence along economic lines.
More than half of patients in neighborhoods with high rates of poverty and unemployment failed to fill prescriptions on time, significantly higher than patients in well-off areas.
Now, researchers at NYU are on a mission to discover why.
status when developing interventions to ensure people with heart failure have access to their medications,” Amrita Mukhopadhyay, a cardiologist, the lead author on the study, and an assistant professor of cardiology said in a statement.
Surprisingly, neither access to transportation nor the density of local pharmacies played a major role in the study’s outcome. The team plans to take a closer look at other factors impacting people in challenged neighborhoods, senior author Samrachana Adhikari said in a statement.
“Now that we have uncovered this disparity at a neighborhood level, we next need to explore additional barriers patients may be facing, such as the cost of medications, language barriers, and discrimination by pharmacy staff,” Adhikari said.
For the study, published in December in JAMA Open Network, the researchers examined pickup patterns for patients with systolic heart failure — a chronic condition that occurs when the heart’s left ventricle (muscle chamber) can’t pump blood properly.
Patients with this type of heart failure utilize “quadruple therapy,” a combination of four drugs that reduces death risk by 400%. Despite the method’s effectiveness, past research notes that 40-50% of these patients don’t pick up their medicine from the pharmacy according to the schedule provided by their doctor.
52% of patients living in the most socioeconomically disadvantaged communities didn’t pick up their medicine on-time.
The team dug into health records and pharmacy data from 6,247 adults with a heart diagnosis failure from within the NYU Langone Medical Center system. The majority were male and averaged 73-years-old.
Across race and ethnicity, 1,011 (16.2%) were Black, 735 (11.8%) were Hispanic/Latinx, and 3,929 (62.9%) were white.
After grouping neighborhoods in the New York metropolitan area by socioeconomic status, the authors calculated the rates at which patients filled their prescriptions over a six-month period.
The major finding: 52% of patients living in the most socioeconomically disadvantaged communities didn’t pick up their medicine on time, compared to 40% of patients in neighborhoods with higher status.
The disparity of 11% “is important because even differences in medication adherence of five to 10 percent can result in increased risk of death,” the university wrote.
Past research has also linked neighborhood socioeconomic status — a combination of income, education, property values, and other factors — to prescription rates for other heart conditions. Its connection to kidney disease and diabetes medication fillings has also been studied.
However, this study was the first of its kind to explore the impact of socioeconomic status on prescription fills for systolic heart failure, which requires multiple prescriptions, according to NYU.
These results support targeting interventions that have already been shown to improve medication adherence, such as patient education programs and frequent follow-up with healthcare professionals.
SAUL B. BLECKER, A CO-AUTHOR OF THE STUDY
Saul B. Blecker, a co-author of the study and an associate professor in the departments of Population Health and Medicine at NYU Langone, said their work should fuel investment in solutions for impacted people, “such as patient education programs and frequent follow-up with healthcare professionals.”
“These results support targeting interventions that have already been shown to improve medication adherence,” she said in a statement.
