Association between long-term adherence to class-I recommended medications and risk for potentially preventable heart failure hospitalizations among younger adults

Five guideline-recommended medication categories are available to treat patients who have heart failure (HF) with reduced ejection fraction. However, adherence to these medications is often suboptimal, which places patients at increased risk for poor health outcomes, including hospitalization. We ai...

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Bibliographic Details
Published in:PloS one 2019-09, Vol.14 (9), p.e0222868-e0222868
Main Authors: Chang, Tiffany E, Park, Soyoun, Yang, Quanhe, Loustalot, Fleetwood, Butler, Javed, Ritchey, Matthew D
Format: Article
Language:English
Subjects:
Adolescent
Adrenergic beta-antagonists
Adult
Adults
Age Factors
Aldosterone
Algorithms
Analysis
Angiotensin
Angiotensin-converting enzyme inhibitors
Angiotensins
Biology and Life Sciences
Cardiac output
Care and treatment
Categories
Chronic illnesses
Confidence intervals
Congestive heart failure
Diagnosis
Disease prevention
Drug therapy
Drugs
Enzyme inhibitors
Enzymes
Eplerenone
Female
Future predictions
Glucocorticoids
Health aspects
Health risks
Heart
Heart diseases
Heart failure
Heart Failure - diagnosis
Heart Failure - drug therapy
Heart Failure - prevention & control
Hospitalization - statistics & numerical data
Humans
Hydralazine
Isosorbide dinitrate
Male
Medical care quality
Medication Adherence - statistics & numerical data
Medicine and Health Sciences
Middle Aged
Nitrates
Patient compliance
Peptidyl-dipeptidase A
Practice Guidelines as Topic
Practice Patterns, Physicians
Prevention
Risk Factors
Stroke
Time Factors
Young Adult
Young adults
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Summary:Five guideline-recommended medication categories are available to treat patients who have heart failure (HF) with reduced ejection fraction. However, adherence to these medications is often suboptimal, which places patients at increased risk for poor health outcomes, including hospitalization. We aimed to examine the association between adherence to these medications and potentially preventable HF hospitalizations among younger insured adults with newly diagnosed HF. Using the 2008-2012 IBM MarketScan Commercial database, we followed 26,439 individuals aged 18-64 years with newly diagnosed HF and calculated their adherence (using the proportion of days covered (PDC) algorithm) to the five guideline-recommended medication categories: angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers; beta blockers; aldosterone receptor antagonists; hydralazine; and isosorbide dinitrate. We determined the association between PDC and long-term preventable HF hospitalizations (observation years 3-5) as defined by the United States (U.S.) Agency for Healthcare Research and Quality. Overall, 49.0% of enrollees had good adherence (PDC≥80%), which was more common among enrollees who were older, male, residing in higher income counties, initially diagnosed with HF in an outpatient setting, and who filled prescriptions for fewer medication categories assessed. Adherence differed by medication category and was lowest for isosorbide dinitrate (PDC = 60.7%). In total, 7.6% of enrollees had preventable HF hospitalizations. Good adherers, compared to poor adherers (PDC
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0222868