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

Abstract

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.

Towards better reporting of the proportion of days covered method in cardiovascular medication adherence: A scoping review and new tool TEN‐SPIDERS

“…and 26 (35%) were related to secondary prevention (Table 1). 6,67–93 Lipid‐lowering medicines were the most commonly investigated cardiovascular medicine (36%). The majority of the scientific articles were observational studies (93%), conducted in Europe (31%) or the USA (47%), and included ≥10 000 individuals (52%).…”

Evidence-based medication adherence among seniors in the first year after heart failure hospitalisation and subsequent long-term outcomes: a restricted cubic spline analysis of adherence-outcome relationships

“…We identified a cohort of 4234 seniors, aged 65–84 years, with an index (first-in-period) hospitalisation for HF in 2003–2008 as a principal diagnosis (International Classification of Diseases and Related Health Problems 10th revision Australian Modification code I50) or HF as a secondary diagnosis and ischemic heart disease (IHD) as a principal diagnosis. The method used to identify the cohort and to identify HF and other comorbidities has been previously described [ 12 , 23 ]. The coded hospital discharge diagnosis of HF has been previously validated by medical chart review [ 27 ].…”

“…Briefly, the Hospital Morbidity Data Collection from the Western Australian Data Linkage System was used to identify patients with hospitalisation for HF from 1 January 2003 to 31 December 2008, and linked to matching death records from the Western Australian death registry [24,25]. Pharmaceutical Benefits Scheme (PBS) claims data were used to identify matching records for the dispensing of RASI or β-blockers approved for HF (bisoprolol, carvedilol, metoprolol tartrate, metoprolol succinate and nebivolol) using their Anatomical Therapeutic Chemical (ATC) codes between June 2002 and June 2011 in concessional health card holders [12,23,26].…”

“…1 Flowchart of patient selection for the study cohort. WA, Western Australia; IHD, ischemic heart disease; HF, heart failure; PBS, Pharmaceutical Benefits Scheme required to have 2 or more supplies of the drug class in order to calculate the adherence measure (PDC) more precisely [12,23]. Medication adherence estimates were calculated for RASI and β-blockers using the PDC method as previously described [15,23].…”

“…Estimates of adherence to RASIs and β-blockers in HF patients vary considerably, ranging from 40 to over 90% depending on the method of estimating adherence, length of observation and the cohort characteristics [5,6,[11][12][13][14]. Studies of adherence using pharmacy claims data have mostly calculated the proportion of days covered (PDC) for each medication [15,16] and categorised a PDC threshold of 80% as being sufficiently adherent without testing if this cut-off was associated with optimal outcomes [4,7,11,13,16,17].…”