Timing of follow-up visits after heart failure doesn’t improve medication adherence

Speedy follow-up with patients after heart failure hospitalizations doesn’t boost medication adherence long-term, researchers reported April 1 in the Journal of the American Heart Association.

Senior author Adrian F. Hernandez, MD, MHS, with Duke University School of Medicine, and colleagues studied 9,878 Medicare Part D beneficiaries who were discharged from Get With the Guidelines-Heart Failure hospitals from April 2006 to October 2012.

“Despite advances in knowledge of the pathophysiology of heart failure (HF) and an expanding array of evidence‐based, guideline‐directed treatment options, once patients develop HF, their rates of hospitalization and mortality have remained relatively unchanged,” the authors wrote. “One potential contributing factor to the persistence of poor outcomes is challenges with medication adherence, which is a critical self‐care behavior for patients with HF.”

One year after discharge, medication adherence was 53 percent for beta-blockers, 48 percent for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, 40 percent for anticoagulants and 8 percent for hydralazine/isosorbide dinitrate. The researchers considered a patient to be adherent to medication if they had filled prescriptions to cover at least 80 percent of days for the year.

Notably, they found adherence rates were similar regardless how quickly a patient was seen in a first follow-up visit after being hospitalized for heart failure. Even those seen less than a week after discharge showed roughly the same adherence rates as those who didn’t have their first follow-up visit until six weeks later.

“Previous studies may have been overly optimistic about the benefits of early follow‐up in and of itself, and the marginal benefits may not translate to all aspects of care, such as medication adherence,” Hernandez et al. wrote.There remains a limited understanding to delineate specific factors associated with increased medication adherence that can guide development of successful, implementable interventions.”

The authors acknowledged their study was limited by its retrospective nature and by including only patients 65 and older with Medicare Part D coverage.