Discontinuation of angiotensin-converting enzyme inhibitors or beta-blockers and the impact on heart failure hospitalization rates

Abstract

Background: Adherence to evidence-based therapy is essential for optimal management of heart failure. Yet, medication adherence is poor in heart failure patients. The Ascertaining Barriers to Compliance Project decomposed the medication adherence process into initiation, implementation, and discontinuation stages, but electronic monitoring-based adherence analyses usually do not consider this process. Aims: The aim of this study was to describe individual-patient patterns of medication adherence from electronic monitoring data among adults with chronic heart failure, adherence types, and risk factors for increased all-cause hospitalization including measures of poor adherence such as discontinuation. Methods: Data from two prospective studies of adherence measured with electronic monitoring for heart failure patients were combined and restricted to monitoring of angiotensin-converting enzyme inhibitors and beta-blockers over an initial three-month period. Hospitalizations were recorded for this period as well as for a three-month follow-up period. Analyses were conducted using adaptive modeling methods to identify individual-patient adherence patterns, adherence types, and risk factors for an increased hospitalization rate. Results: Using electronic monitoring data for 254 heart failure patients, four adherence types were identified: highly consistent, consistent but variable, moderately consistent, and poorly consistent. Sixteen individually significant risk factors for increased hospitalization rates were identified and used to generate a multiple risk factors model. Medication discontinuation was the most important individual risk factor and most important in the multiple risk factors model. Conclusion: Discontinuation of angiotensin-converting enzyme inhibitors or beta-blockers increases hospitalization rates for heart failure patients. Interventions that effectively address this problem are urgently needed.

Usefulness of a Nurse-Led Program of Care for Management of Patients with Chronic Heart Failure

“…In addition, the QoL and rehospitalization due to CHF exacerbation were also improved, which we considered might be at least partly due to the higher rate of adherence to medications therapy. Indeed, evidence from prior studies also demonstrated that CHF patients with good adherence to medications therapy had lower incidence of rehospitalization and mortality [24][25][26]. However, as presented in Table 2, although patients in the intervention group had higher rates of adherence to medications therapy than in the control group, compared to medications prescribed at discharge, the percentage of patients who continued on these medications therapy declined.…”