Influence of drug adherence and medical care on heart failure outcome in the primary care setting in Austria

Beatrice A. Marzluf; Berthold Reichardt; Lisa Maria Neuhofer; Bernhard Kogler; Michael Wolzt

doi:10.1002/pds.3790

May 18, 2015Pharmacoepidemiology and Drug Safety

Influence of drug adherence and medical care on heart failure outcome in the primary care setting in Austria

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Why the study?

Does adherence to drug therapy and non-drug medical care improve survival and reduce readmission in patients with heart failure?

Structured PICO

Does adherence to drug therapy and non-drug medical care improve survival and reduce readmission in patients with heart failure?

P

Population

36,829 patients hospitalised for heart failure who survived more than 90 days after discharge between April 2006 and June 2010, mean age 77.1 ± 10.8 years, 44.8% men, from 13 Austrian health insurance funds.

I

Intervention

Adherence to guideline-recommended drug therapy (ACEi/ARB, beta-blockers, aldosterone antagonists) and primary non-drug medical care (NDMC, measured by physician consultations and diagnostic tests).

C

Comparator

Lower adherence to drug therapy and lower consumption of non-drug medical care.

O

Outcome

Survival, death without further admission for HF, and readmission for HF.hard clinical

Guideline-recommended drug therapy remains underutilized in Austria, but higher drug adherence and quality of non-drug medical care are independently associated with better survival in heart failure patients.

Implication

Adherence and non-drug care may improve HF survival; leaves open whether interventions reduce readmission or mortality.

Abstract

PURPOSE: Guideline-recommended therapy has been proven beneficial in heart failure (HF), but general implementation remains poor. The aim of this study was to evaluate the adherence to drug therapy, quality of primary non-drug medical care (NDMC) and its impact on HF outcome. METHODS: From 13 Austrian health insurance funds, we identified 36 829 patients (77.1 ± 10.8 years, 44.8% men) hospitalised for HF who survived more than 90 days after discharge in the period between April 2006 and June 2010. Drug adherence was analysed from prescriptions filled and NDMC from numbers of physician consultations and diagnostic tests relevant for HF per quarter of a year (medical care index (MedCI)) claimed from the insurance funds. Kaplan-Meier and multivariate Cox regression analyses were performed to identify the association of outcome (survival and death without further admission for HF, readmission for HF) with drug adherence and NDMC. RESULTS: Readmission due to HF or death without prior readmission for HF occurred in 19.7% and 22.5%, respectively. Adherence to angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, beta-blockers and aldosterone antagonists was 49.3%, 40.4% and 16.1%, respectively, and was associated with better survival by Kaplan-Meier analysis. NDMC was consumed less frequently by deceased (76.0%; MedCI 2.55 ± 3.04) than surviving (79.3%; 3.60 ± 3.81) or readmitted (78.4%; 3.80 ± 4.13) patients (p < 0.001 for deceased vs both other). Drug adherence and NDMC were independent factors associated with better survival by multivariate regression analysis. CONCLUSION: Guideline-recommended drug therapy remains underutilised in Austria. Drug adherence and quality of NDMC are associated with better outcome in HF patients.