Abstract
Purpose
Disease management programs have been associated with improved adherence to heart
failure (HF) medications. However, there remain limited data on the benefit of a comprehensive
multidisciplinary HF postdischarge management (PDM) clinic that promptly follows HF-related
hospitalization on evidence-based HF medication adherence.
Objective
The aim of this study was to evaluate the effects of an HF-PDM clinic on adherence
to evidence-based HF medication therapy.
Methods
In this retrospective cohort study, we identified patients discharged from the Veterans
Affairs Greater Los Angeles Healthcare System between 2009 and 2012 with a primary
diagnosis of HF. Data from patients who attended the HF-PDM clinic immediately following
HF-related hospitalization between 2010 and 2012 were compared with those from historical
controls, who did not attend the HF-PDM clinic, from 2009. The main outcome was adherence
to evidence-based HF medications during the 90 days after discharge. Adherence was defined as the proportion of days covered at 90 days after discharge (PDC-90)
of ≥0.80. The percentages of patients adherent to each medication were compared between
the 2 groups using the χ2 test. A logistic regression model adjusted for potential confounding variables was
constructed to evaluate the percentages of patients adherent to evidence-based HF
medications.
Findings
A total of 277 patients (144 clinic, 133 control) were included in the study. Both
univariate and multivariate analyses showed that the clinic was associated with improved
medication adherence to angiotensin-converting enzyme inhibitors, a twice-daily β-blocker,
and aldosterone antagonists compared with controls. The most significant increases
were in adherence to angiotensin-converting enzyme inhibitors, with mean PDC-90 values
of 0.84 (control) versus 0.93 (clinic) (P = 0.008) and 90-day adherence rates of 69% (control) versus 87% (clinic) (P = 0.005).
Implications
Care in the multidisciplinary HF-PDM clinic was associated with significant increases
in 90-day adherence to evidence-based HF medications in patients who were recently
discharged after an HF-related hospitalization.
Key words
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Article info
Publication history
Published online: May 22, 2017
Accepted:
April 29,
2017
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
