{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,12]],"date-time":"2026-09-12T17:59:56Z","timestamp":1789235996107,"version":"build-2803163510"},"reference-count":51,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"13","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec id=\"jah311125-sec-0001\" xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Mechanisms for worse prognosis after myocardial infarction in low socioeconomic status are unclear. We therefore investigated the association between socioeconomic status and discontinuation of evidence\u2010based secondary prevention drug therapies.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311125-sec-0002\" xml:lang=\"en\">\n            <jats:title>Methods<\/jats:title>\n            <jats:p xml:lang=\"en\">All patients with a first\u2010ever myocardial infarction, on treatment with a statin (n=60\u2009717), antithrombotic therapy (n=65\u2009862), or a renin\u2010angiotensin\u2010aldosterone\u2010system inhibitor (n=51\u2009486) at the routine 1\u2010year visit in SWEDEHEART (Swedish Web\u2010System for Enhancement and Development of Evidence\u2010Based Care in Heart Disease Evaluated According to Recommended Therapies) between January 2006 and mid\u20102020 were included in this population\u2010based nationwide cohort study. Individual\u2010level socioeconomic status was measured by disposable income quintile, region of birth, and educational level. Outcomes were discontinuation (&gt;180\u2009days without a new prescription claim) of statins, antithrombotic therapies, and renin\u2010angiotensin\u2010aldosterone\u2010system\u2010inhibitors. Bias\u2010minimized multivariable adjusted hazard ratios (aHRs) were estimated during follow\u2010up until December 2020.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311125-sec-0003\" xml:lang=\"en\">\n            <jats:title>Results<\/jats:title>\n            <jats:p xml:lang=\"en\">Discontinuation occurred more often in the lowest versus highest income quintile for statins (aHR, 1.25 [95% CI, 1.20\u20131.31]), antithrombotic therapy (aHR, 1.26 [95% CI, 1.20\u20131.32]), and renin\u2010angiotensin\u2010aldosterone\u2010system inhibitors (aHR, 1.32 [95% CI, 1.26\u20131.39]). Discontinuation of statins was more frequent among immigrants (versus nonimmigrants) born in other Nordic (aHR, 1.24 [95% CI, 1.17\u20131.32]), other European (aHR, 1.40 [95% CI, 1.33\u20131.47]), Asian (aHR, 1.45 [95% CI, 1.36\u20131.56]), and other world regions (aHR, 1.63 [95% CI, 1.45\u20131.84]). Associations between immigrant background and discontinuation of antithrombotic therapies and renin\u2010angiotensin\u2010aldosterone\u2010system inhibitors were even stronger. Lower (versus tertiary) educational level was inversely associated with discontinuation of secondary prevention drug classes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec id=\"jah311125-sec-0004\" xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">Despite Swedish universal health care, discontinuation of evidence\u2010based drugs post myocardial infarction is strongly associated with disposable income and immigrant background. Further study on strategies to improve adherence in low socioeconomic status post myocardial infarction is warranted.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.124.041781","type":"journal-article","created":{"date-parts":[[2025,6,24]],"date-time":"2025-06-24T00:04:21Z","timestamp":1750723461000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Income\u2010Level and Immigrant Status Are Associated With Discontinuation of Evidence\u2010Based Secondary Prevention Therapies After Myocardial Infarction"],"prefix":"10.1161","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6841-1904","authenticated-orcid":false,"given":"Joel","family":"Ohm","sequence":"first","affiliation":[{"name":"Karolinska Institutet","place":["Stockholm, Sweden"]},{"name":"Karolinska University Hospital","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kevin","family":"Ma","sequence":"additional","affiliation":[{"name":"Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Freyland","sequence":"additional","affiliation":[{"name":"Karolinska Institutet","place":["Stockholm, Sweden"]},{"name":"Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0196-4894","authenticated-orcid":false,"given":"Ali","family":"Yari","sequence":"additional","affiliation":[{"name":"Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1695-379X","authenticated-orcid":false,"given":"Tomas","family":"Jernberg","sequence":"additional","affiliation":[{"name":"Karolinska Institutet","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0372-6272","authenticated-orcid":false,"given":"Per","family":"Svensson","sequence":"additional","affiliation":[{"name":"Karolinska Institutet","place":["Stockholm, Sweden"]},{"name":"S\u00f6dersjukhuset","place":["Stockholm, Sweden"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehz425"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2021.1129"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1177\/2047487318766646"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.123.064440"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/eht295"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.7326\/M18-0543"},{"key":"e_1_3_2_8_2","doi-asserted-by":"publisher","DOI":"10.1146\/annurev-publhealth-032013-182419"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2796.2003.01178.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.7326\/M18-3079"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1136\/hrt.2010.198804"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/ehjqcco\/qcab039"},{"key":"e_1_3_2_13_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10654-019-00511-8"},{"key":"e_1_3_2_14_2","unstructured":"The National Board of Health and Welfare . 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