Clinical InvestigationHeart FailureTransitional adherence and persistence in the use of aldosterone antagonist therapy in patients with heart failure
Section snippets
Data sources
We obtained clinical data for the study from the GWTG-HF registry and Medicare claims data from the Centers for Medicare & Medicaid Services. The GWTG-HF program is implemented voluntarily by hospitals8 and succeeded the OPTIMIZE-HF registry.9 Briefly, patients are eligible for inclusion in the registry if they are hospitalized for heart failure as a primary reason for admission or if they develop significant symptoms of heart failure during hospitalization. Patients are identified based on
Results
The Figure shows the composition of the study cohort. The initial linked data set consisted of 11,381 patients. After all exclusions, the study cohort included 2,086 patients eligible for aldosterone antagonist therapy at discharge. Patients who met the inclusion criteria differed from those who did not. Eligible patients were younger, more likely to be women, more likely to have heart failure of ischemic etiology, and less likely to have a history of anemia or depression (Table I). One-third
Discussion
To our knowledge, ours is the first study to combine data from a national inpatient clinical registry with Medicare prescription drug event data to examine adherence to evidence-based therapy for heart failure during the transition from hospital to home. Among eligible patients, only 1 in 5 was prescribed aldosterone antagonist therapy at discharge; of those, >78% filled the prescription within 90 days of discharge. In contrast, only 13% of eligible patients who were not prescribed an
Acknowledgements
Damon M. Seils, MA, Duke University, provided editorial assistance and prepared the manuscript.
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James L. Januzzi, MD, served as guest editor for this article.