Research Article| Volume 39, ISSUE 6, P1200-1209, June 2017

Impact of a Multidisciplinary Heart Failure Postdischarge Management Clinic on Medication Adherence



      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.


      The aim of this study was to evaluate the effects of an HF-PDM clinic on adherence to evidence-based HF medication therapy.


      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.


      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).


      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.

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        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • et al.
        • American Heart Association Statistics Committee and Stroke Statistics Subcommittee
        Heart disease and stroke statistics: 2014 update.
        Circulation. 2014; 129: e28-e292
      1. Veterans Health Administration Facility Quality and Safety Report Fiscal Year 2012 Data. Accessed October 5, 2015.

        • Yancy C.W.
        • Jessup M.
        • Bozkurt B.
        • et al.
        • American College of Cardiology Foundation
        • American Heart Association Task Force on Practice Guidelines
        2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2013; 62: e147-e239
        • Lindenfeld J.
        • Albert N.M.
        • Boehmer J.P.
        • et al.
        • Heart Failure Society of America
        HFSA 2010 comprehensive heart failure practice guideline.
        J Card Fail. 2010; 16: e1-e194
        • Wu J.R.
        • Moser D.K.
        • Lennie T.A.
        • Burkhart P.V.
        Medication adherence in patients who have heart failure: a review of the literature.
        Nurs Clin North Am. 2008; 43 (vii–viii): 133-153
        • Böhm M.
        • Schumacher H.
        • Laufs U.
        • et al.
        Effects of nonpersistence with medication on outcomes in high-risk patients with cardiovascular disease.
        Am Heart J. 2013; 166: e7
        • Ambardekar A.V.
        • Fonarow G.C.
        • Hernandez A.F.
        • et al.
        • Get With the Guidelines Steering Committee and Hospitals
        Characteristics and in-hospital outcomes for nonadherent patients with heart failure: findings from Get With The Guidelines–Heart Failure (GWTG-HF).
        Am Heart J. 2009; 158: 644-652
        • Phillips C.O.
        • Wright S.M.
        • Kern D.E.
        • et al.
        Comprehensive discharge planning with post-discharge support for older patients with congestive heart failure.
        JAMA. 2004; 291: 1358-1367
        • Luzier A.B.
        • Forrest A.
        • Feuerstein S.G.
        • et al.
        Containment of heart failure hospitalizations and cost by angiotensin-converting enzyme inhibitor dosage optimization.
        Am J Cardiol. 2000; 86: 519-523
        • Antonicelli R.
        • Mazzanti I.
        • Abbatecola A.M.
        • Parati G.
        Impact of home patient telemonitoring on use of β-blockers in congestive heart failure.
        Drugs Aging. 2010; 27: 801-805
        • Murray M.D.
        • Young J.
        • Hoke S.
        • et al.
        Pharmacist intervention to improve medication adherence in heart failure.
        Ann Intern Med. 2007; 146: 714-715
        • Jackevicius C.A.
        • de Leon N.K.
        • Lu L.
        • et al.
        Impact of a multidisciplinary heart failure post-hospitalization program on heart failure readmission rates.
        Ann Pharmacother. 2015; 49: 1189-1196
        • Lamb D.
        • Eurich D.T.
        • McAlister F.A.
        • et al.
        Changes in adherence to evidence-based medications in the first year after initial hospitalization for heart failure: observational cohort study from 1994 to 2003.
        Circ Cardiovasc Qual Outcomes. 2009; 2: 228-235
        • Tsuyuki R.T.
        • Olson K.L.
        • Dubyk A.M.
        • et al.
        Effect of community pharmacist intervention on cholesterol levels in patients at high risk of cardiovascular events: the Second Study of Cardiovascular Risk Intervention by Pharmacists (SCRIP-plus).
        Am J Med. 2004; 116: 130-133
        • Stewart S.
        • Horowitz J.D.
        Detecting early clinical deterioration in chronic heart failure patients post-acute hospitalisation—a critical component of multidisciplinary, home-based intervention?.
        Eur Heart Failure. 2002; 4: 345-351
        • Windham B.G.
        • Bennett R.G.
        • Gottlieb S.
        Care management interventions for older patients with congestive heart failure.
        Am J Manag Care. 2003; 9: 447-459
        • Riegel B.
        • Lee C.S.
        • Ratcliffe S.J.
        • et al.
        Predictors of objectively measured medication nonadherence in adults with heart failure.
        Circ Heart Fail. 2012; 5: 430-436
        • Vrijens B.
        • Vincze G.
        • Kristanto P.
        • et al.
        Adherence to prescribed antihypertensive drug treatments: longitudinal study of electronically compiled dosing histories.
        BMJ. 2008; 336: 1114-1117
        • Coleman C.I.
        • Limone B.
        • Sobieraj D.M.
        • et al.
        Dosing frequency and medication adherence in chronic disease.
        J Manag Care Pharm. 2012; 18: 527-539
        • Coleman C.I.
        • Roberts M.S.
        • Sobieraj D.M.
        • et al.
        Effect of dosing frequency on chronic cardiovascular disease medication adherence.
        Curr Med Res Opin. 2012; 28: 669-680