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Circulation. 2015 Oct 6;132(14):1347-53. doi: 10.1161/CIRCULATIONAHA.115.014281. Epub 2015 Aug 27.

Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures.

Author information

1
From Division of Cardiology and the Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora (L.A.A., F.A.M., J.S.R., P.M.H.); University of California Los Angeles Medical Center, Los Angeles (G.C.F.); Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (L.L., P.L.S., Z.J.E., A.F.H., E.D.P.); Veterans Affairs Medical Center, Denver, CO (J.S.R., P.M.H.); Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA (P.A.H.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Section of Cardiovascular Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.). larry.allen@ucdenver.edu.
2
From Division of Cardiology and the Colorado Cardiovascular Outcomes Research Consortium, University of Colorado School of Medicine, Aurora (L.A.A., F.A.M., J.S.R., P.M.H.); University of California Los Angeles Medical Center, Los Angeles (G.C.F.); Duke Clinical Research Institute and Duke University Medical Center, Durham, NC (L.L., P.L.S., Z.J.E., A.F.H., E.D.P.); Veterans Affairs Medical Center, Denver, CO (J.S.R., P.M.H.); Veterans Affairs Palo Alto Healthcare System, Palo Alto, CA (P.A.H.); Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, Boston, MA (D.L.B.); Section of Cardiovascular Medicine and Robert Wood Johnson Foundation Clinical Scholars Program, Department of Medicine, Yale School of Medicine, New Haven, CT (H.M.K.); and Department of Health Policy and Management, Yale School of Public Health; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.).

Abstract

BACKGROUND:

Guidelines for heart failure (HF) recommend prescription of guideline-directed medical therapy before hospital discharge; some of these therapies are included in publicly reported performance measures. The burden of new medications for individual patients has not been described.

METHODS AND RESULTS:

We used Get With The Guidelines-HF registry data from 2008 to 2013 to characterize prescribing, indications, and contraindications for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, aldosterone antagonists, hydralazine/isosorbide dinitrate, and anticoagulants. The difference between a patient's medication regimen at hospital admission and that recommended by HF quality measures at discharge was calculated. Among 158 922 patients from 271 hospitals with a primary discharge diagnosis of HF, initiation of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was indicated in 18.1% of all patients (55.5% of those eligible at discharge were not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers at admission), β-blockers in 20.3% (50.5% of eligible), aldosterone antagonists in 24.1% (87.4% of eligible), hydralazine/isosorbide dinitrate in 8.6% (93.1% of eligible), and anticoagulants in 18.0% (58.0% of eligible). Cumulatively, 0.4% of patients were eligible for 5 new medication groups, 4.1% for 4 new medication groups, 9.4% for 3 new medication groups, 10.1% for 2 new medication groups, and 22.7% for 1 new medication group; 15.0% were not eligible for new medications because of adequate prescribing at admission; and 38.4% were not eligible for any medications recommended by HF quality measures. Compared with newly indicated medications (mean, 1.45 ± 1.23), actual new prescriptions were lower (mean, 1.16 ± 1.00).

CONCLUSIONS:

A quarter of patients hospitalized with HF need to start >1 medication to meet HF quality measures. Systems for addressing medication initiation and managing polypharmacy are central to HF transitional care.

KEYWORDS:

heart failure; medication adherence; medication therapy management; prescribing patterns, physician; quality of health care

PMID:
26316616
PMCID:
PMC4941099
DOI:
10.1161/CIRCULATIONAHA.115.014281
[Indexed for MEDLINE]
Free PMC Article
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