Timing of Postdischarge Follow‐Up and Medication Adherence Among Patients With Heart Failure

Abstract

Background Medication adherence improves outcomes for patients with heart failure, but adherence rates remain low. We examined the association between earlier postdischarge follow‐up and medication adherence. Methods and Results We performed a retrospective cohort study of patients ≥65 years who were hospitalized for heart failure, covered by Medicare Part D, and discharged alive from April 2006 to October 2012 using the Get With The Guidelines‐Heart Failure Registry linked to Medicare claims. Patients were categorized into 4 groups by timing of first postdischarge follow‐up visit: ≤1, 1 to 2, 2 to 6, and >6 weeks. Medication adherence was defined by proportion of days covered of >80% at 90 days and 1‐year posthospital discharge to 5 guideline‐directed medical therapies (angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker, evidence‐based β‐blocker, aldosterone antagonist, hydralazine/isosorbide dinitrate, and anticoagulation for atrial fibrillation). Among 9878 patients with heart failure, 73% had left ventricular ejection fraction ≤40%, median age was 78 years (25th–75th percentile, 71–84), and 48% were male. Overall, 30% had a follow‐up appointment within 1‐week postdischarge and 25% >6 weeks. At 1 year, medication adherence was 53% for evidence‐based β‐blockers, 48% for angiotensin‐converting enzyme inhibitors/angiotensin receptor blockers, and 8% for hydralazine/isosorbide dinitrate. We found no significant association between timing of first follow‐up visit and medication adherence at 1 year (1.04, 0.92–1.17) when comparing follow‐up visits >6 weeks to the earliest ones. Conclusions Posthospital heart failure discharge, overall adherence to medical therapies in Medicare beneficiaries was low. Early follow‐up was not associated with increased medication adherence to guideline‐directed medical therapy in the short or long term.