Timing of Postdischarge Follow‐Up and Medication Adherence Among Patients With Heart Failure

Abstract

BackgroundMedication adherence improves outcomes for patients with heart failure, but adherence rates remain low. We examined the association between earlier postdischarge follow‐up and medication adherence.Methods and ResultsWe performed a retrospective cohort study of patients ≥65 years who were hospitalized for heart failure, covered by Medicare Part D, and discharged alive from April 2006 to October 2012 using the Get With The Guidelines‐Heart Failure Registry linked to Medicare claims. Patients were categorized into 4 groups by timing of first postdischarge follow‐up visit: ≤1, 1 to 2, 2 to 6, and >6 weeks. Medication adherence was defined by proportion of days covered of >80% at 90 days and 1‐year posthospital discharge to 5 guideline‐directed medical therapies (angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, evidence‐based β‐blocker, aldosterone antagonist, hydralazine/isosorbide dinitrate, and anticoagulation for atrial fibrillation). Among 9878 patients with heart failure, 73% had left ventricular ejection fraction ≤40%, median age was 78 years (25th–75th percentile, 71–84), and 48% were male. Overall, 30% had a follow‐up appointment within 1‐week postdischarge and 25% >6 weeks. At 1 year, medication adherence was 53% for evidence‐based β‐blockers, 48% for angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and 8% for hydralazine/isosorbide dinitrate. We found no significant association between timing of first follow‐up visit and medication adherence at 1 year (1.04, 0.92–1.17) when comparing follow‐up visits >6 weeks to the earliest ones.ConclusionsPosthospital heart failure discharge, overall adherence to medical therapies in Medicare beneficiaries was low. Early follow‐up was not associated with increased medication adherence to guideline‐directed medical therapy in the short or long term.

Association between long-term adherence to class-I recommended medications and risk for potentially preventable heart failure hospitalizations among younger adults

“…Inpatient hospitalization days for any cause were excluded from the PDC calculation. Based on prior studies, good adherence was defined as PDC ≥80% [25, 26], and then the PDC <80% group was further categorized as having moderate (PDC 40-<80%) or poor (PDC <40%) adherence [27, 28] to assess for associations between these levels of adherence and hospitalizations. For enrollees who filled prescriptions for more than one included medication category, an unweighted simple mean of the PDCs for each category was calculated.…”

The implementation cost of a safety‐net hospital program addressing social needs in Atlanta

“…These rates are an increase from prior years and may be higher than what has been reported in the literature; however, are not necessarily comparable. [46][47][48][49][50][51] Historically, social and health care services are funded by different systems and have not been integrated. 12 We focus on a cost analysis of GHFP to answer the following question: What does it cost annually for a safety-net hospital to advance health equity by using a health care intervention that integrates social needs activities into clinical care?…”

Chronic heart failure and adherence to medication: methods for assessing adherence to therapy and unresolved issues

“…Раннее обращение после выписки в поликлинику и своевременное посещение лечебно-профилактического учреждения не были связаны с лучшей приверженностью этих пациентов. Через 1 год приверженность β-АБ была 53 %, иАПФ и блокаторам рецепторов ангиотензина -48 % [32].…”