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Adherence to Disease-Modifying Therapy in Patients Hospitalized for HF: Findings from a Community-Based Study

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Abstract

Background

Much data about prescription adherence in patients with heart failure (HF) are available, but few exist about the evaluation of true patient adherence. Further, methods for analyzing this issue are poorly known.

Objectives

Our objective was to evaluate the impact of patient adherence to disease-modifying drugs after HF hospitalization in a community-based cohort.

Methods and Results

Patients hospitalized with first diagnostic HF code and at least one post-discharge purchase of evidence-based drugs for HF between 2009 and 2015 were included (12,938 patients). A new method for measuring adherence to polypharmacy (patient adherence indicator [PAI]) was introduced, based on proportion of days covered (PDC) and medication possession ratio (MPR). The investigated drugs were β-blockers (BBs), angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARBs), and anti-aldosterone agents (AAs). Regional administrative databases were analyzed.

Results

The mean age of the cohort was 80 years; 53% was female; the median Charlson Comorbidity Index score was 2, and the overall death rate was 60%. PAI based on PDC estimated a nonadherence rate of 47%. Median daily dosages were well below target dosages for all drugs considered. A good PAI significantly lowered the mortality risk, irrespective of the computational method used: PDC (PAI adjusted hazard ratio [HR] 0.93; 95% confidence interval [CI] 0.88–0.97; p = 0.001) or MPR (PAI adjusted HR 0.93; 95% CI 0.89–0.98; p = 0.004).

Conclusions

In a real-world setting, medication adherence of patients with HF remains unsatisfactory, especially when in a polypharmacy setting. Irrespective of PDC and MPR, good patient adherence to polypharmacy was associated with a lower death rate.

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Author information

Authors and Affiliations

  1. MOX, Department of Mathematics, Politecnico di Milano, Milan, Italy

    Marta Spreafico, Francesca Gasperoni & Francesca Ieva

  2. Biostatistics Unit, Department of Medical Sciences, University of Trieste, Trieste, Italy

    Giulia Barbati & Arjuna Scagnetto

  3. CHRP-National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy

    Marta Spreafico, Giulia Barbati & Francesca Ieva

  4. CADS-Center for Analysis, Decisions and Society, Human Technopole, Milan, Italy

    Francesca Ieva

  5. Servizio Epidemiologico e Flussi Informativi, EGAS, Regione autonoma Friuli Venezia Giulia, Udine, Italy

    Loris Zanier

  6. Cardiology Unit, Papa Giovanni XXIII Hospital, Bergamo, Italy

    Annamaria Iorio

  7. Cardiovascular Department, Azienda Sanitaria Universitaria Integrata of Trieste, Trieste, Italy

    Gianfranco Sinagra

  8. Cardiovascular Center, Azienda Sanitaria Universitaria Integrata of Trieste, Trieste, Italy

    Andrea Di Lenarda

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  1. Marta Spreafico
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Corresponding author

Correspondence to Giulia Barbati.

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Funding

No sources of funding were used to conduct this study or prepare this manuscript.

Conflict of interest

Marta Spreafico, Francesca Gasperoni, Giulia Barbati, Francesca Ieva, Arjuna Scagnetto, Loris Zanier, Annamaria Iorio, Gianfranco Sinagra, and Andrea Di Lenarda have no potential conflicts of interest that might be relevant to the contents of this manuscript.

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Spreafico, M., Gasperoni, F., Barbati, G. et al. Adherence to Disease-Modifying Therapy in Patients Hospitalized for HF: Findings from a Community-Based Study. Am J Cardiovasc Drugs 20, 179–190 (2020). https://doi.org/10.1007/s40256-019-00367-z

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