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Post-Discharge Clinic at VA Increases Heart Failure Medication Adherence

by U.S. Medicine

June 30, 2017

LOS ANGELES – Adherence to heart failure (HF) medications has shown improvement with disease management programs, leading a new study to pose the question: How much would it help to have a comprehensive multidisciplinary HF post-discharge (PDM) clinic promptly following hospitalization?

The results of the research were published recently in the journal Clinical Therapeutics.1

For the retrospective cohort study, VA Greater Los Angeles Healthcare System researchers and colleagues identified patients discharged from the VA facility between 2009 and 2012 with a primary diagnosis of HF.

The study team compared data from patients who attended the HF-PDM clinic immediately following HF-related hospitalization between 2010 and 2012 to those from 2009 historical controls, who did not attend the HF-PDM clinic. Adherence to evidence-based HF medications during the 90 days after discharge was considered the primary outcome.

For purposes of the study, adherence was defined as the proportion of days covered at 90 days after discharge (PDC-90) greater than or equal to 0.80. The study included 277 patients — 144 in the clinic group and 133 in the control group.

Results indicated that both univariate and multivariate analyses showed that the clinic was associated with improved medication adherence to angiotensin-converting enzyme inhibitors, a twice-daily β-blocker, and aldosterone antagonists compared with controls.

The most significant increases were in adherence to angiotensin-converting enzyme inhibitors, with mean PDC-90 values of 0.84 (control) vs. 0.93 (clinic), as well as 90-day adherence rates of 69% (control) vs. 87% (clinic).

 “Care in the multidisciplinary HF-PDM clinic was associated with significant increases in 90-day adherence to evidence-based HF medications in patients who were recently discharged after an HF-related hospitalization,” study authors concluded.

1.    Lu L, Jackevicius CA, de Leon NK, Warner AL, Chang DS, Mody FV. Impact of aMultidisciplinary Heart Failure Postdischarge Management Clinic on MedicationAdherence. Clin Ther. 2017 Jun;39(6):1200-1209. doi:10.1016/j.clinthera.2017.04.012. Epub 2017 May 22. PubMed PMID: 28545803.


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