Treatment Initiation Patterns, Modifications, and Medication Adherence Among Newly Diagnosed Heart Failure Patients: A Retrospective Claims Database Analysis

Deschaseaux, C.; McSharry, Martin; Hudson, Eibhlin; Agrawal, R.; Turner, Stuart

doi:10.18553/jmcp.2016.22.5.561

Cited by 30 publications

(31 citation statements)

References 26 publications

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“…Pre‐LVAD medication use was significantly associated with better adherence for β‐blockers and loop diuretics; familiarity with and tolerance of these medications before LVAD placement may have contributed to better adherence post‐LVAD. Studies have demonstrated that nonadherence to HF treatments is associated with increased risk of hospital readmission and death, and that interventions to improve adherence can improve these outcomes . Further work is needed to delineate the reasons for nonadherence after LVAD and examine the associations of nonadherence and outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have demonstrated that nonadherence to HF treatments is associated with increased risk of hospital readmission and death, and that interventions to improve adherence can improve these outcomes. 6,22,29 Further work is needed to delineate the reasons for nonadherence after LVAD and examine the associations of nonadherence and outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…However, these data are based on institutional reporting of medications prescribed to patients and do not account for whether patients fill and take their medications as prescribed. Because medication nonadherence is common in patients with cardiovascular diseases such as HF and is significantly associated with differences in outcomes, it is of critical importance to consider adherence when examining patterns of medication use . Given the above, we therefore aimed to fill these knowledge gaps by evaluating use of and adherence to HF medications in the year following LVAD implantation in a large commercially insured population.…”

Section: Introductionmentioning

confidence: 99%

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Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Tan

Sangaralingham

Schilz

et al. 2017

JAHA

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BackgroundThere are few data describing the longitudinal use of and adherence to heart failure medications following left ventricular assist device (LVAD) implantation.Methods and ResultsUsing a large US commercial insurance database, patients who received an LVAD (International Classification of Diseases, 9th Revision, Clinical Modification code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1‐year post‐LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post‐LVAD medication use and poor medication adherence (proportion of days covered <0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and loop diuretics did not change. Pre‐LVAD medication use was associated with post‐LVAD use across all medication classes. The proportion of patients with poor medication adherence was 28.8%, 39.0%, and 36.0% for β‐blockers, angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and anticoagulants, respectively. Many patients with poor adherence completely discontinued use of the medication.ConclusionsNeurohormonal antagonist use after LVAD was inconsistent, perhaps reflecting uncertainty of therapeutic benefit in this population. Medication adherence post‐LVAD was poor in many patients. Further work is needed to delineate the reasons for nonadherence after LVAD.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Tan

Sangaralingham

Schilz

et al. 2017

JAHA

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“…Interestingly, similar findings have been found in other countries: in one study of patients treated for newly diagnosed heart failure, the greatest rate of compliance was observed for β -blockers, followed by ACE inhibitors. 29 In another study based on a large database of Catalonian e -prescriptions, the lowest rate of primary nonadherence across all assessed drug classes was observed for ACE inhibitors. 20 Perhaps one of the key drivers of this phenomenon is a very low level of adverse effects in the case of ACE inhibitors, and the contrary in the case of diuretics.…”

Section: Primary Nonadherence In the Subgroup Of Drugs Of Key Importancementioning

confidence: 94%

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

Kardas

Cieszyński

Czech³

et al. 2019

Polish Archives of Internal Medicine

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IntroductIon Primary nonadherence to medication occurs when a patient does not fill a prescription and often leads to suboptimal patient outcomes, lost productivity, and increased net costs. Pilot introduction of electronic prescriptions (e-prescriptions) in Poland took place in 2018, enabling nationwide assessment of primary nonadherence. objEctIvEs To determine the prevalence and drivers of primary nonadherence in Poland. MEthods This retrospective analysis included data from all e-prescriptions issued in Poland in 2018. Primary nonadherence was defined as not filling a prescription within 1 month from the date of issuing. rEsuLts Out of all 119 880 e-prescriptions issued in Poland in 2018, 94 913 were filled, thus the primary nonadherence rate reached 20.8%. Although no differences in primary nonadherence were observed between sexes, age was found to have a significant effect, with older groups showing lower rates of primary nonadherence. In addition, slightly lower rates of primary nonadherence (17.0%) were found for e-prescriptions issued for selected drugs of key importance (n = 47 492). Multivariable analysis performed within this subset showed that those aged ≥75 years had the lowest odds for nonadherence (odds ratio, 0.55; 95% CI, 0.48-0.64). Differences in primary nonadherence rates were observed across therapeutic areas (lowest value in antibiotics, 14.3%), drug classes (lowest value in sulfonylureas, 13.2%), and individual drugs. Primary nonadherence rates were lower for drugs covered by the "Leki 75+" program, which makes them free of charge for those aged 75 years or older. concLusIons A high percentage of prescriptions issued in Poland are never filled. E-prescriptions allow the identification and analysis of drivers of this phenomenon. Our findings may help designing national health and medicine policies.

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“…However, Deschaseaux et al . used the Truven Health Market Scan database to determine that 42% of patients with a new diagnosis of heart failure were not prescribed any heart failure‐specific therapy within 30 days of discharge . Unfortunately, the investigators were unable to determine how many of these patients had HFrEF compared with other forms of heart failure; the study needs to be repeated.…”

mentioning

confidence: 99%

‘Drugs don't work in patients who don't take them’ (C. Everett Koop, MD, US Surgeon General, 1985)

Lindenfeld

Jessup

2017

European J of Heart Fail

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Treatment Initiation Patterns, Modifications, and Medication Adherence Among Newly Diagnosed Heart Failure Patients: A Retrospective Claims Database Analysis

Cited by 30 publications

References 26 publications

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Longitudinal Heart Failure Medication Use and Adherence Following Left Ventricular Assist Device Implantation in Privately Insured Patients

Primary non-adherence to medication and its drivers of in Poland: findings of the analysis of the e-prescription pilot

‘Drugs don't work in patients who don't take them’ (C. Everett Koop, MD, US Surgeon General, 1985)

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