ASPIRIN TREATMENT AFTER MYOCARDIAL-INFARCTION - ARE HEALTH MAINTENANCE ORGANIZATION MEMBERS, WOMEN, AND THE ELDERLY UNDERTREATED

In April 1996, we surveyed 539 patients who had suffered a myocardial infarction in 1995 to determine whether the prescription and use of as pirin after myocardial infarction differs by patient age, sex, and typ e of health insurance. Patients who were insured through one of four h ealth maintenance organizations in major metropolitan areas or by an i ndemnity plan in 40 states completed the survey. Among the 502 patient s with no contraindications to use, 93.8% were prescribed aspirin, Amo ng patients with a prescription and no subsequent contraindications to use, 96.4% were taking aspirin when surveyed. Among aspirin users, 96 .5% reported taking aspirin daily. Controlling for other characteristi cs, 75-year-old patients were 5 percentage points less likely to recei ve a prescription for aspirin than were 50-year-old patients (P = 0.05 ). Although not significant at conventional levels, point estimates re vealed a prescription rate for women that was 6 percentage points high er than that for men (P = 0.054) and a rate for health maintenance org anization members that was 4 percentage points lower than that for pat ients with indemnity insurance (P = 0.10). Aspirin use was lower among older patients (P = 0.02) but did not differ by gender or type of ins urance plan, Health maintenance organization members were just as like ly to receive a prescription from a specialist as were those with inde mnity insurance (P = 0.92). Based on these results, the rate of aspiri n treatment after myocardial infarction may be much higher than previo us studies indicate. Concerns that managed care patients and women may be undertreated are not supported by our findings. Although older pat ients are at risk for undertreatment, this risk is low. Once aspirin i s prescribed, self-reported patient compliance with a daily regimen of aspirin is high.