Medication initiation burden required to comply with heart failure guideline recommendations and hospital quality measures

Larry A. Allen, Gregg C. Fonarow, Li Liang, Phillip J. Schulte, Frederick A. Masoudi, John S. Rumsfeld, P. Michael Ho, Zubin J. Eapen, Adrian F. Hernandez, Paul A. Heidenreich, Deepak L. Bhatt, Eric D. Peterson, Harlan M. Krumholz

Research output: Contribution to journalArticle

34 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)1347-1353
Number of pages7
JournalCirculation
Volume132
Issue number14
DOIs
StatePublished - Oct 6 2015

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Allen, L. A., Fonarow, G. C., Liang, L., Schulte, P. J., Masoudi, F. A., Rumsfeld, J. S., Ho, P. M., Eapen, Z. J., Hernandez, A. F., Heidenreich, P. A., Bhatt, D. L., Peterson, E. D., & Krumholz, H. M. (2015). Medication initiation burden required to comply with heart failure guideline recommendations and hospital quality measures. Circulation, 132(14), 1347-1353. https://doi.org/10.1161/CIRCULATIONAHA.115.014281