Loading...
Causes and consequences of nonpersistence with heart failure medication.
Mockler, Mary O'Loughlin, Christina Murphy, Niamh Ryder, Mary Conlon, Carmel McDonald, Kenneth Michael Ledwidge, Mark Thomas
Mockler, Mary
O'Loughlin, Christina
Murphy, Niamh
Ryder, Mary
Conlon, Carmel
McDonald, Kenneth Michael
Ledwidge, Mark Thomas
Advisors
Editors
Other Contributors
Date
2012-02-01T10:29:15Z
Date Submitted
Keywords
Other Subjects
Subject Mesh
Aged
Aged, 80 and over
Female
Heart Failure/*drug therapy
Hospitalization/*statistics & numerical data
Humans
Male
Middle Aged
*Patient Compliance
Retrospective Studies
Aged, 80 and over
Female
Heart Failure/*drug therapy
Hospitalization/*statistics & numerical data
Humans
Male
Middle Aged
*Patient Compliance
Retrospective Studies
Planned Date
Start Date
Collaborators
Principal Investigators
Alternative Titles
Publisher
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
ISSN
1879-1913 (Electronic)
0002-9149 (Linking)
0002-9149 (Linking)
eISSN
ISBN
DOI
10.1016/j.amjcard.2008.11.058
PMID
19268741