Association Between Adherence Measurements of Metoprolol and Health Care Utilization in Older Patients with Heart Failure*

Tu, Wanzhu; Morris, Andrew; Li, Jingjin; Wu, Jingwei; Young, James; Brater, D. Craig; Murray, Michael D.

doi:10.1016/j.clpt.2004.10.004

Cited by 37 publications

(28 citation statements)

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“…Avoiding hospitalization for heart failure (HF) is an important goal for this population, and understanding predictors of HF is the first step toward targeted prevention measures. In addition to cardiac physiology, psychosocial factors may contribute to HF hospitalizations (Howie-Esquivel & Dracup, 2007; Jiang et al, 2007; Sherwood et al, 2007), through both increased physiologic stress and through patient behaviors such as inadequate medication adherence (Murray et al, 2007; Tu et al, 2005). …”

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confidence: 99%

Self-efficacy as a marker of cardiac function and predictor of heart failure hospitalization and mortality in patients with stable coronary heart disease: Findings from the Heart and Soul Study.

2009

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Objective-The authors sought to evaluate the association of self-efficacy with objective measures of cardiac function, subsequent hospitalization for heart failure (HF), and all-cause mortality.Design-Observational cohort of ambulatory patients with stable CHD. The authors measured selfefficacy using a published, validated, 5-item summative scale, the Sullivan Self-Efficacy to Maintain Function Scale. The authors also performed a cardiac assessment, including an exercise treadmill test with stress echocardiography.Main Outcome Measures-Hospitalizations for HF, as determined by blinded review of medical records, and all-cause mortality, with adjustment for demographics, medical history, medication use, depressive symptoms, and social support.Results-Of the 1,024 predominately male, older CHD patients, 1013 (99%) were available for follow-up, 124 (12%) were hospitalized for HF, and 235 (23%) died during 4.3 years of follow-up. Mean cardiac self-efficacy score was 9.7 (SD 4.5,, corresponding to responses between "not at all confident" and "somewhat confident" for ability to maintain function. Lower self-efficacy predicted subsequent HF hospitalization (OR per SD decrease = 1.4, p = 0006), and all-cause mortality (OR per SD decrease = 1.4, p < .0001). After adjustment, the association of cardiac selfefficacy with both HF hospitalization and mortality was explained by worse baseline cardiac function.Conclusion-Among patients with CHD, self-efficacy was a reasonable proxy for predicting HF hospitalizations. The increased risk of HF associated with lower baseline self-efficacy was explained by worse cardiac function. These findings indicate that measuring cardiac self-efficacy provides a rapid and potentially useful assessment of cardiac function among outpatients with CHD. As mortality from coronary heart disease (CHD) improves in the acute setting, improving care and outcomes for those with stable CHD assumes greater importance for public health. Avoiding hospitalization for heart failure (HF) is an important goal for this population, and understanding predictors of HF is the first step toward targeted prevention measures. In addition to cardiac physiology, psychosocial factors may contribute to HF hospitalizations (HowieEsquivel & Dracup, 2007;Jiang et al., 2007;Sherwood et al., 2007), through both increased physiologic stress and through patient behaviors such as inadequate medication adherence (Murray et al., 2007;Tu et al., 2005). KeywordsSelf-efficacy is a psychological construct based on social-cognitive theory, which describes the interaction between behavioral, personal, and environmental factors in health and chronic disease (Bandura, 1977(Bandura, , 1997Lorig & Holman, 2003). The theory of self-efficacy proposes that patients' confidence in their ability to perform certain health behaviors influences their engagement in and actual performance of those behaviors (e.g., diet and exercise adherence), which in turn influence health outcomes. Indeed, the construct of self-efficacy has extended far beyond...

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confidence: 99%

Self-efficacy as a marker of cardiac function and predictor of heart failure hospitalization and mortality in patients with stable coronary heart disease: Findings from the Heart and Soul Study.

2009

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“…The included studies focussed on a wide range of disease areas including pulmonary diseases, osteoporosis, depression, cardiovascular diseases, Parkinson's disease, epilepsy, chronic kidney disease, cancer and diabetes mellitus . Two studies did not measure disease‐specific medication (non‐)adherence .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies did not measure disease‐specific medication (non‐)adherence . Thirty‐six studies were specific to, or provided age stratified analysis for people aged ≥64 years, while the other 30 studies also included middle aged adults (≥50 years) . Thirteen authors of the included texts were contacted via e‐mail for further information, and 8 replied.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen authors of the included texts were contacted via e‐mail for further information, and 8 replied. In terms of adherence measurement, 54 studies measured medication (non‐)adherence using pharmacy claims data while 11 studies used self‐report methods, consisting of the 4‐item or 8‐item Morisky Medication Adherence Scale, or self‐reported PDC and MEMs was used in 4 studies …”

Section: Resultsmentioning

confidence: 99%

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The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

Walsh

Cahir

Tecklenborg

et al. 2019

Brit J Clinical Pharma

123

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Aims The aim of this systematic review and meta‐analysis was to synthesise the evidence relating to medication non‐adherence and its association with health outcomes in people aged ≥50 years. Methods Seven databases were searched up to February 2019 for observational studies that measured medication (non‐)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264). Results Sixty‐six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta‐analyses. A meta‐analysis including 3 studies measuring medication non‐adherence in adults aged ≥55 years showed a significant association with all‐cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta‐analysis including 2 studies showed that medication non‐adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long‐term mortality risk in comparison to medication non‐adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98). Conclusion Medication non‐adherence may be significantly associated with all‐cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.

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“…Therefore, in heart failure patients who are hypertensive, MS is an obvious choice given its FDA-approved indication for heart failure. Moreover, the pharmacokinetic profile of MT is associated with higher utilization of health care services and inferior outcomes when compared with MS in heart failure patients 26. In addition to the inferiority of MT, heart failure is associated with a higher risk of hospitalization, which can lead to increased costs; prevention of hospitalization with the use of MS can save money in the long run in this patient population 27…”

Section: Discussionmentioning

confidence: 99%

Health expenditure comparison of extended-release metoprolol succinate and immediate-release metoprolol tartarate

Vaidya

Patel²

2012

CEOR

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BackgroundMetoprolol, a selective beta-1 blocker, is available in two different salt forms in the market – metoprolol succinate (MS) and metoprolol tartarate (MT). Both the formulations are Food and Drug Administration approved for the treatment of hypertension. Several studies have shown similar efficacies between the two salts; however, they differ in their pharmacokinetic properties and are therefore priced differently. The primary objective of this study was to compare the overall health care expenditures of hypertensive patients on MT and MS to see if the price difference in the two preparations is offset by savings in overall expenditure.MethodsTwo cohorts of patients using MT and MS were selected from the 2008 Medical Expenditure Panel Survey. Propensity score matching technique was used to balance the cohorts on various parameters such as demographic information, insurance status, and comorbidity score. Patients using MT were matched to patients using MS on the logit of propensity score using calipers of width equal to 0.2 of the standard deviation of the logit of the propensity score. Multiple regression analysis was carried out to examine the association between health expenditure and type of metoprolol salt, adjusting for other covariates.ResultsA total of 742 patients were found to use metoprolol (MT-388, MS-354). After propensity score matching, a total of 582 patients were left in the sample for final analysis (291 patients in each cohort). The average annual health care expenditure was slightly higher in the MT cohort; however, after adjusting for covariates in a multivariate analysis, the difference was found to be statistically insignificant (P = 0.23).ConclusionBoth the products of metoprolol were found to have similar average annual total health care expenditure; however, MS once a day has higher out-of-pocket cost.

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Association Between Adherence Measurements of Metoprolol and Health Care Utilization in Older Patients with Heart Failure*

Cited by 37 publications

References 32 publications

Self-efficacy as a marker of cardiac function and predictor of heart failure hospitalization and mortality in patients with stable coronary heart disease: Findings from the Heart and Soul Study.

Self-efficacy as a marker of cardiac function and predictor of heart failure hospitalization and mortality in patients with stable coronary heart disease: Findings from the Heart and Soul Study.

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

Health expenditure comparison of extended-release metoprolol succinate and immediate-release metoprolol tartarate

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