Adherence to ESC guideline‐recommended medications over a 36‐month follow‐up period after hospitalization for heart failure: Results from the EPICAL2 cohort study

Bitar, Sandy El; Agrinier, Nelly; Alla, François; Rossignol, Patrick; Mebazaa, Alexandre; Thilly, Nathalie

doi:10.1002/pds.4868

Cited by 11 publications

(12 citation statements)

References 40 publications

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“…6,[13][14][15][16][17][18] Almost all adherence studies limited their observation period to around 1 year, 19 but a recent European study has shown that around 64% of patients with HF with reduced ejection fraction remained adherent to dual therapy (RASI and b-blocker) over a 3-year period after hospital discharge. 20 However, little is known about the long-term adherence to EBMs among Australian patients with hospitalized HF, which predominantly affects older patients with a high comorbidity burden that may impact adherence. 21,22 An understanding of the longterm adherence to EBMs and their clinical predictors in a "real-world" population-based HF cohort is necessary to inform targets and potential need for strategies to improve adherence and expected HF outcomes.…”

Section: Introductionmentioning

confidence: 99%

Long-Term Adherence to Renin–Angiotensin System Inhibitors and β-Blockers After Heart Failure Hospitalization in Senior Patients

Qin

Hung

Teng

et al. 2020

J Cardiovasc Pharmacol Ther

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Aims: We investigated long-term adherence to renin–angiotensin system inhibitors (RASIs) and β-blockers, and associated predictors, in senior patients after hospitalization for heart failure (HF). Methods: A population-based data set identified 4488 patients who survived 60 days following their index hospitalization for HF in Western Australia from 2003 to 2008 with a 3-year follow-up. Their person-linked Pharmaceutical Benefits Scheme records identified medications dispensed during follow-up. Drug discontinuation was defined as the first break ≥90 days following the previous supply. Medication adherence was calculated using the proportion of days covered (PDC), with PDC ≥ 80% defined as being adherent. Multivariable logistic regression models were used to identify predictors of PDC < 80%. Results: In the cohort (57% male, mean age: 76.6 years), 77.4% were dispensed a RASI and 52.7% a β-blocker within 60 days postdischarge. Over the 3-year follow-up, 28% and 42% of patients discontinued RASI and β-blockers, respectively. Only 64.6% and 47.5% of RASI and β-blocker users, respectively, were adherent to their treatment over 3 years, with adherence decreasing over time (trend P < .0001 for RASI and trend P = .02 for β-blockers). Older age, increasing Charlson comorbidity score, chronic kidney disease, and chronic obstructive pulmonary disease were independent predictors of PDC < 80% for both drug groups. Conclusion: Among seniors hospitalized for HF, discontinuation gaps were common for RASI and β-blockers postdischarge, and long-term adherence to these medications was suboptimal. Where appropriate, strategies to improve long-term medication adherence are indicated in HF patients, particularly in elderly patients with comorbidities.

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Section: Introductionmentioning

confidence: 99%

Long-Term Adherence to Renin–Angiotensin System Inhibitors and β-Blockers After Heart Failure Hospitalization in Senior Patients

Qin

Hung

Teng

et al. 2020

J Cardiovasc Pharmacol Ther

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“…Poor drug adherence or non‐persistence in patients with HF have in several studies demonstrated increased morbidity and mortality, as well as increased healthcare costs. 5 , 6 , 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

“…Poor drug adherence or non-persistence in patients with HF have in several studies demonstrated increased morbidity and mortality, as well as increased healthcare costs. [5][6][7][8] Studies on drug adherence and persistence are important for patients, caregivers, and decision makers to understand targets for implementation of guideline-directed medical therapy (GDMT). Interventions that improve adherence and persistence might have higher impact on HF outcomes than new drugs in the real-world setting.…”

Section: Introductionmentioning

confidence: 99%

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Adherence and persistence to pharmacotherapy in patients with heart failure: a nationwide cohort study, 2014–2020

et al. 2022

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AimsWe aimed to study initiation, adherence, and long-term persistence to beta-blockers (BB), renin-angiotensin system inhibitors (RASi), and mineralocorticoid receptor antagonists (MRA) in a nationwide cohort of patients with heart failure (HF). Methods Patients aged 18-80 years in Norway with a first diagnosis of HF from 2014 until 2020 that survived ≥30 days were identified from the Norwegian Patient Registry and linked to the Norwegian Prescription Database. We collected information about BB, RASi [angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), and angiotensin receptor-neprilysin inhibitors (ARNI)], and MRA. Dual HF therapy was defined as taking at least two out of three drug classes, whereas triple HF therapy was defined as taking all three. Initiation (time to initiation) and persistence (time to discontinuation using a grace period of 30 days) of HF drugs was calculated by the Kaplan-Meier method, followed to outcome of interest, death, or December 2020. One-year adherence was measured as proportion of days covered (PDC) using a cut-off at 80%. For adherence and persistence measurements, we allowed for maximum 60 days of stockpiling and switching within drug groups. We performed sensitivity analyses to test the robustness of our findings. Results Out of 54 899 patients included in the cohort, 75%, 69%, and 21% initiated a BB, RASi, and MRA, respectively, whereas 13% did not receive any. Dual and triple HF therapy was prescribed to 61% and 16%, respectively. The proportion of adherent patients during the first year following initiation was 83%, 81%, 84%, and 61% for BB, RASi, ARNI, and MRA, whereas 42% and 5% were adherent to dual and triple HF therapy, respectively. From 2 to 5 years following initiation, persistence decreased from 58% to 38%, 57% to 37%, and 31% to 15% for BB, RASi, and MRA, respectively. Within the RASi group, persistence was higher for ARNI than for ACEI and ARB. There were no major changes in either initiation or adherence of the drug classes from 2014 to 2019, except for an increase in initiation and adherence of MRA. Conclusions We found low adherence to dual and triple HF therapies in this nationwide cohort study of newly diagnosed HF patients. Efforts are needed to increase adherence and persistence to HF therapies into clinical practice, emphasizing maintenance of multiple drug therapies in patients with such an indication.

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“…Although ACEI/ARB use is crucial for HFrEF patients, the underutilization of these medications is commonly seen in clinical practice. Bertero et al[27] has reported common factors associated with the nonprescription of ACEI/ARB including higher serum creatinine level, lower systolic blood pressure, and old age. Medication dose reduction is needed in advanced chronic kidney disease.…”

mentioning

confidence: 99%

Influence of Chronic Obstructive Pulmonary Disease on Long-term Hospitalization and Mortality in Patients with Heart Failure with Reduced Ejection Fraction

Lin

Yeh

Lin

et al. 2022

Preprint

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Background: Heart failure with reduced ejection fraction (HFrEF) can coexist with chronic obstructive pulmonary disease (COPD), which complicates the clinical situation and worsens quality of life. The study used standard diagnostic criteria for detecting COPD in hospitalized HFrEF patients and to determine the impact of other comorbidities and medications on the long-term outcomes of HFrEF + COPD patients.Methods: We retrospectively recruited patients hospitalized due to HFrEF in a tertiary medical center and examined and followed up clinical outcomes, including length of hospital stay, mortality, and readmission episodes, for a 5-year period. Risk factors for mortality were analyzed using multivariate analysis. Results: Of the 118 hospitalized HFrEF study participants, 68 had concurrent COPD whereas 50 did not. There was a significant increase in the male predominance, smoking history, lower left ventricular ejection fraction, and higher hemoglobin level and increased length of hospital stay in the HF + COPD group than in the HF-only group. In multivariate analysis, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker (ACEI/ARB) use independently predicted 5-year all-cause mortality. Oral corticosteroid use and stroke as a comorbidity were independently associated with a shorter time to the first readmission episode. Conclusion: In HFrEF patients, COPD was associated with a prolonged length of hospital stay. ACEI/ARB use was independently associated with a beneficial effect on survival in HF patients with COPD. Long-term oral corticosteroid use in patients with both HF and COPD should be crucially evaluated to determine the clinical benefit and disadvantages.

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Adherence to ESC guideline‐recommended medications over a 36‐month follow‐up period after hospitalization for heart failure: Results from the EPICAL2 cohort study

Cited by 11 publications

References 40 publications

Long-Term Adherence to Renin–Angiotensin System Inhibitors and β-Blockers After Heart Failure Hospitalization in Senior Patients

Long-Term Adherence to Renin–Angiotensin System Inhibitors and β-Blockers After Heart Failure Hospitalization in Senior Patients

Adherence and persistence to pharmacotherapy in patients with heart failure: a nationwide cohort study, 2014–2020

Influence of Chronic Obstructive Pulmonary Disease on Long-term Hospitalization and Mortality in Patients with Heart Failure with Reduced Ejection Fraction

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