TY - JOUR
T1 - Longitudinal heart failure medication use and adherence following left ventricular assist device implantation in privately insured patients
AU - Tan, Nicholas Y.
AU - Sangaralingham, Lindsey R.
AU - Schilz, Stephanie R.
AU - Dunlay, Shannon M.
N1 - Funding Information:
The study was funded by the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Dr Dunlay is funded by a National Institutes of Health Career Development Award (K23 HL 116643).
Publisher Copyright:
© 2017 The Authors.
PY - 2017/10/1
Y1 - 2017/10/1
N2 - Background-There are few data describing the longitudinal use of and adherence to heart failure medications following left ventricular assist device (LVAD) implantation. Methods and Results-Using a large US commercial insurance database, patients who received an LVAD (International Classification of Diseases, 9th Revision, Clinical Modification code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1-year post-LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post-LVAD medication use and poor medication adherence (proportion of days covered <0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and b-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and loop diuretics did not change. Pre-LVAD medication use was associated with post-LVAD use across all medication classes. The proportion of patients with poor medication adherence was 28.8%, 39.0%, and 36.0% for b-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and anticoagulants, respectively. Many patients with poor adherence completely discontinued use of the medication. Conclusions-Neurohormonal antagonist use after LVAD was inconsistent, perhaps reflecting uncertainty of therapeutic benefit in this population. Medication adherence post-LVAD was poor in many patients. Further work is needed to delineate the reasons for nonadherence after LVAD. (J Am Heart Assoc. 2017;6:e005776. DOI: 10.1161/JAHA.117.005776.).
AB - Background-There are few data describing the longitudinal use of and adherence to heart failure medications following left ventricular assist device (LVAD) implantation. Methods and Results-Using a large US commercial insurance database, patients who received an LVAD (International Classification of Diseases, 9th Revision, Clinical Modification code 37.66) and survived to hospital discharge without heart transplantation between January 1, 2006, and March 31, 2015, were identified. Heart failure medication use from 3 months before 1-year post-LVAD was examined using linked pharmacy claims. Differences in the proportion of patients taking heart failure medications post LVAD compared with pre LVAD were examined using McNemar test. Predictors of post-LVAD medication use and poor medication adherence (proportion of days covered <0.8) were identified via logistic regression. Among 362 patients (mean age, 57.4 years; 75.1% men), compared with pre LVAD, the proportion of patients taking anticoagulants and antiarrhythmics following LVAD increased; mineralocorticoid receptor antagonists, thiazide diuretics, and digoxin decreased; and b-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and loop diuretics did not change. Pre-LVAD medication use was associated with post-LVAD use across all medication classes. The proportion of patients with poor medication adherence was 28.8%, 39.0%, and 36.0% for b-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and anticoagulants, respectively. Many patients with poor adherence completely discontinued use of the medication. Conclusions-Neurohormonal antagonist use after LVAD was inconsistent, perhaps reflecting uncertainty of therapeutic benefit in this population. Medication adherence post-LVAD was poor in many patients. Further work is needed to delineate the reasons for nonadherence after LVAD. (J Am Heart Assoc. 2017;6:e005776. DOI: 10.1161/JAHA.117.005776.).
KW - Advanced heart failure
KW - Left ventricular assist device
KW - Medication adherence
UR - http://www.scopus.com/inward/record.url?scp=85032230366&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85032230366&partnerID=8YFLogxK
U2 - 10.1161/JAHA.117.005776
DO - 10.1161/JAHA.117.005776
M3 - Article
C2 - 28974501
AN - SCOPUS:85032230366
SN - 2047-9980
VL - 6
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 10
M1 - e005776
ER -