Causes and consequences of nonpersistence with heart failure medication.

Hdl Handle:
http://hdl.handle.net/10147/207488
Title:
Causes and consequences of nonpersistence with heart failure medication.
Authors:
Mockler, Mary; O'Loughlin, Christina; Murphy, Niamh; Ryder, Mary; Conlon, Carmel; McDonald, Kenneth Michael; Ledwidge, Mark Thomas
Affiliation:
Heart Failure Unit, St Vincent's University Hospital, Elm Park, Dublin, Ireland.
Citation:
Am J Cardiol. 2009 Mar 15;103(6):834-8.
Journal:
The American journal of cardiology
Issue Date:
1-Feb-2012
URI:
http://hdl.handle.net/10147/207488
DOI:
10.1016/j.amjcard.2008.11.058
PubMed ID:
19268741
Abstract:
Persistence with therapy may be more easily and objectively identified in the clinical setting than compliance and recent work has shown it to be linked to mortality in heart failure (HF). The aim of this study was to determine the extent, causes, and clinical impact of nonpersistence with disease-modifying therapy in a retrospective cohort study of 183 patients with systolic HF participating in a disease management program. The main outcome measurements were reasons/determinants of nonpersistence and its impact on hospitalizations. Fifty-three patients (29%) had 74 separate occurrences of nonpersistence with disease-modifying therapy. There was no medical reason for discontinuing medications in 50% of occurrences, whereas medication was discontinued for an adverse reaction in 30% and for a justified medical reason in 15% of occurrences. Nonpersistence was a significant predictor of all-cause readmission (hazard ratio 3.20, 95% confidence interval 1.74 to 11.37) and cardiovascular readmission (hazard ratio 4.45, 95% confidence interval 1.74 to 11.37). In the adjusted model, there was no significantly increased risk of HF readmission (hazard ratio 2.41, 95% confidence interval 0.88 to 6.62). In conclusion, nonpersistence with HF therapy is common, is often not medically justified, and is associated with an increased risk of hospitalization.
Language:
eng
MeSH:
Aged; Aged, 80 and over; Female; Heart Failure/*drug therapy; Hospitalization/*statistics & numerical data; Humans; Male; Middle Aged; *Patient Compliance; Retrospective Studies
ISSN:
1879-1913 (Electronic); 0002-9149 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorMockler, Maryen_GB
dc.contributor.authorO'Loughlin, Christinaen_GB
dc.contributor.authorMurphy, Niamhen_GB
dc.contributor.authorRyder, Maryen_GB
dc.contributor.authorConlon, Carmelen_GB
dc.contributor.authorMcDonald, Kenneth Michaelen_GB
dc.contributor.authorLedwidge, Mark Thomasen_GB
dc.date.accessioned2012-02-01T10:29:15Z-
dc.date.available2012-02-01T10:29:15Z-
dc.date.issued2012-02-01T10:29:15Z-
dc.identifier.citationAm J Cardiol. 2009 Mar 15;103(6):834-8.en_GB
dc.identifier.issn1879-1913 (Electronic)en_GB
dc.identifier.issn0002-9149 (Linking)en_GB
dc.identifier.pmid19268741en_GB
dc.identifier.doi10.1016/j.amjcard.2008.11.058en_GB
dc.identifier.urihttp://hdl.handle.net/10147/207488-
dc.description.abstractPersistence with therapy may be more easily and objectively identified in the clinical setting than compliance and recent work has shown it to be linked to mortality in heart failure (HF). The aim of this study was to determine the extent, causes, and clinical impact of nonpersistence with disease-modifying therapy in a retrospective cohort study of 183 patients with systolic HF participating in a disease management program. The main outcome measurements were reasons/determinants of nonpersistence and its impact on hospitalizations. Fifty-three patients (29%) had 74 separate occurrences of nonpersistence with disease-modifying therapy. There was no medical reason for discontinuing medications in 50% of occurrences, whereas medication was discontinued for an adverse reaction in 30% and for a justified medical reason in 15% of occurrences. Nonpersistence was a significant predictor of all-cause readmission (hazard ratio 3.20, 95% confidence interval 1.74 to 11.37) and cardiovascular readmission (hazard ratio 4.45, 95% confidence interval 1.74 to 11.37). In the adjusted model, there was no significantly increased risk of HF readmission (hazard ratio 2.41, 95% confidence interval 0.88 to 6.62). In conclusion, nonpersistence with HF therapy is common, is often not medically justified, and is associated with an increased risk of hospitalization.en_GB
dc.language.isoengen_GB
dc.subject.meshAgeden_GB
dc.subject.meshAged, 80 and overen_GB
dc.subject.meshFemaleen_GB
dc.subject.meshHeart Failure/*drug therapyen_GB
dc.subject.meshHospitalization/*statistics & numerical dataen_GB
dc.subject.meshHumansen_GB
dc.subject.meshMaleen_GB
dc.subject.meshMiddle Ageden_GB
dc.subject.mesh*Patient Complianceen_GB
dc.subject.meshRetrospective Studiesen_GB
dc.titleCauses and consequences of nonpersistence with heart failure medication.en_GB
dc.contributor.departmentHeart Failure Unit, St Vincent's University Hospital, Elm Park, Dublin, Ireland.en_GB
dc.identifier.journalThe American journal of cardiologyen_GB
dc.description.provinceLeinster-

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