Clinical InvestigationImpact of Medication Nonadherence on Hospitalizations and Mortality in Heart Failure
Section snippets
Study Population
We conducted a retrospective longitudinal cohort study of members of Kaiser Permanente Colorado (KPCO) with heart failure. KPCO is a nonprofit managed care organization that provides health care services to >450,000 members in the Denver metropolitan area. We identified patients with a primary hospital discharge diagnosis of heart failure (index hospitalization) between January 1, 2001, and December 31, 2006. We included only patients with a primary discharge diagnosis of heart failure, given
Results
The final cohort consisted of 557 patients (Fig. 1). Excluded patients were older, were more likely to be female, and had a higher incidence of depression, chronic obstructive pulmonary disease, stroke, and hypertension. Included patients were more likely to have coronary artery disease and a higher hematocrit at baseline.
Mean follow-up was 1.1 years. Adherent and nonadherent patients are compared in Table 1. As has been shown in hypertension,23 adherent and nonadherent patients could not be
Discussion
In this community-based cohort of patients with HFrEF, medication nonadherence was common and was associated with a significantly higher risk of all-cause mortality or cardiovascular hospitalization. This association was consistent across individual outcomes, definitions of adherence, and classes of heart failure medications. When adherence was defined using only the first 3 months after the index hospitalization, there was no association with the primary outcome.
Adherence to β-blockers was
Conclusions and Implications
We found that nonadherence to evidence-based pharmacotherapies was associated with an increased risk of all-cause mortality or cardiovascular hospitalization in a community-based cohort of patients with HFrEF. There may be significant benefits on mortality and readmission rates from the development of systems of care that improve adherence.
Disclosure
Dr. Ho is a consultant for Wellpoint.
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