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

• Published in: Clinical therapeutics 2017-06, Vol.39 (6), p.1200-1209
• Main Authors: Lu, Lingyun, PharmD, MSc, Jackevicius, Cynthia A., BScPhm, PharmD, MSc, de Leon, Noelle K., PharmD, Warner, Alberta L., MD, Chang, Donald S., MD, MPH, Mody, Freny Vaghaiwalla, MD
• Format: Article
• Language: English
• Subjects: Adhesion; Adrenergic beta-Antagonists - therapeutic use; Aged; Aged, 80 and over; Aldosterone; Angiotensin; Angiotensin-converting enzyme inhibitors; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Antagonists; Cardiovascular disease; Clinics; Diagnosis; Discharge; Disease control; disease management; Drug therapy; Drugs; Enzyme inhibitors; Enzymes; Female; Health care; Heart; Heart diseases; Heart failure; Heart Failure - drug therapy; Hospitals; Humans; Identification methods; Inhibitors; Internal Medicine; Intervention; Logistic Models; Male; Medical Education; Medical referrals; Medication Adherence; Middle Aged; Mineralocorticoid Receptor Antagonists - therapeutic use; Mortality; Patient compliance; Patient Discharge; Patient Education as Topic; Patients; Peptidyl-dipeptidase A; Pharmacists; Retrospective Studies; Therapy
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2017.04.012

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.