84 ABSTRACT BACKGROUND Clinical guidelines recommend cardioprotective medication use in coronary heart disease (CHD) patients. Underuse of these drugs is common among patients of low resources, which may be explained by insufficient access in the public health sector. We aim to assess medication use and barriers to care by insurance coverage in subjects with CHD in the Southern Cone of Latin America. METHODS We analysed cross-sectional data from 593 participants with CHD residing in Argentina, Chile and Uruguay, within the CESCAS community-based cohort study. Participants were categorized as covered by public insurance only or having additional coverage (social security or private insurance). We calculated the prevalence of recommended medications use, mean number of medications, use of ≥ 1 and ≥ 2 drugs, and reported barriers to needed care by type of insurance coverage. Differences between coverage groups were assessed with logistic and Poisson regression adjusted by age, sex, previous revascularization, educational level and barriers. RESULTS Medication use ranged from 22.3% (lipid-lowering) to 51.9% (antihypertensives). Mean number of medications was 1.8 (SE 0.1), 95.4% used ≥ 1 drugs, and 59.3% used ≥ 2 drugs. There were no significant differences by coverage in medication use, except for lower betablocker use (25.3% vs. 17.1%, p=0.02) and higher ACE-inhibitor use among participants in the public sector (22.5% vs. 31.4%, p=0.03). In the multivariable analysis, having public coverage only was not significantly associated with medication use, but it was with reporting barriers to care (OR 2.06, 95% CI 1.21-3.52). CONCLUSION Insurance coverage was not associated with the use of most medications in CHD patients in the Southern Cone of Latin America, possibly due to public health programs providing them free of charge. Participants in the public sector more often face barriers to access medical care, and future studies should address these healthcare inequalities. KEYWORDS Medication, coronary heart disease, South America, insurance coverage, public health, healthcare system, prevention
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