Transitional adherence and persistence in the use of aldosterone antagonist therapy in patients with heart failure
Transitional adherence and persistence in the use of aldosterone antagonist therapy in patients with heart failure
复制标题
DOI：
10.1016/j.ahj.2013.03.007
复制
发表时间：
2013-06-01
影响因子：
4.8
通讯作者：
Fonarow, Gregg C.
中科院分区：
文献类型：
--
作者：
Curtis, Lesley H.;Mi, Xiaojuan;Fonarow, Gregg C.
背景 醛固酮拮抗剂治疗推荐用于特定的心力衰竭和射血分数降低的患者。从医院到家的过渡过程中对治疗的依从性尚不清楚。 方法 我们在 2005 年 1 月 1 日至 2008 年 12 月 31 日期间通过指南-心力衰竭登记册确定了年龄 >= 65 岁、有资格接受醛固酮拮抗剂治疗并出院回家的心力衰竭和射血分数降低的患者。我们使用 Medicare 处方药事件数据来衡量依从性。主要结果指标是出院时的处方、90 天内的门诊处方索取、停药以及以药物持有率衡量的依从性。我们使用累积发生率函数来估计起始和终止率。结果 在 2,086 名符合条件的患者中，561 名 (26.9%) 在出院时接受了醛固酮拮抗剂治疗。在 90 天内，有出院处方的符合条件的患者中有 78.6% 配药了治疗处方，而没有出院处方的符合条件的患者只有 13.0% (P < .001)。 1 年随访期间，中位药物持有率为 0.63。在出院后 90 天内按处方配药的 634 名患者中，7.9% 在 1 年内停止治疗。结论 大多数符合条件的患者在因心力衰竭住院出院时并未接受醛固酮拮抗剂治疗。没有出院处方的符合条件的患者很少作为门诊患者开始治疗。大多数出院时服用醛固酮拮抗剂的患者会在 90 天内按处方服药并继续接受治疗。
Background Aldosterone antagonist therapy is recommended for selected patients with heart failure and reduced ejection fraction. Adherence to therapy in the transition from hospital to home is not well understood.Methods We identified patients with heart failure and reduced ejection fraction who were >= 65 years old, eligible for aldosterone antagonist therapy, and discharged home from hospitals in the Get With the Guidelines-Heart Failure registry between January 1, 2005, and December 31, 2008. We used Medicare prescription drug event data to measure adherence. Main outcome measures were prescription at discharge, outpatient prescription claim within 90 days, discontinuation, and adherence as measured with the medication possession ratio. We used the cumulative incidence function to estimate rates of initiation and discontinuation.Results Among 2,086 eligible patients, 561 (26.9%) were prescribed an aldosterone antagonist at discharge. Within 90 days, 78.6% of eligible patients with a discharge prescription filled a prescription for the therapy, compared with 13.0% of eligible patients without a discharge prescription (P < .001). The median medication possession ratio was 0.63 over 1 year of follow-up. Among 634 patients who filled a prescription within 90 days of discharge, 7.9% discontinued therapy within 1 year.Conclusion Most eligible patients were not prescribed aldosterone antagonist therapy at discharge from a heart failure hospitalization. Eligible patients without a discharge prescription seldom initiated therapy as outpatients. Most patients who were prescribed an aldosterone antagonist at discharge filled the prescription within 90 days and remained on therapy.