痴呆对患有慢性心力衰竭的医疗保险受益人的药物使用及依从性的影响。
The effect of dementia on medication use and adherence among Medicare beneficiaries with chronic heart failure.
作者信息
Rattinger Gail B, Dutcher Sarah K, Chhabra Pankdeep T, Franey Christine S, Simoni-Wastila Linda, Gottlieb Stephen S, Stuart Bruce, Zuckerman Ilene H
机构信息
Department of Pharmaceutical Health Services Research, School of Pharmacy, University of Maryland, Baltimore, Maryland, USA.
出版信息
Am J Geriatr Pharmacother. 2012 Feb;10(1):69-80. doi: 10.1016/j.amjopharm.2011.11.003. Epub 2012 Jan 20.
BACKGROUND
Alzheimer's disease and related disorders (ADRD) are prevalent in older adults, increase the costs of chronic heart failure (CHF) management, and may be associated with undertreatment of cardiovascular disease.
OBJECTIVE
The purpose of our study was to determine the relationship between comorbid ADRD and CHF medication use and adherence among Medicare beneficiaries with CHF.
METHODS
This 2-year (1/1/2006-12/31/2007) cross-sectional study used data from the Chronic Condition Data Warehouse of the Centers for Medicare and Medicaid Services. Medicare beneficiaries with evidence of CHF who had systolic dysfunction and Medicare Parts A, B, and D coverage during the entire study period were included. ADRD was identified based on diagnostic codes using the Chronic Condition Data Warehouse algorithm. CHF evidence-based medications (EBMs) were selected based on published guidelines: angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, selected β-blockers, aldosterone antagonists, and selected vasodilators. Measures of EBMs included a binary indicator of EBM use and medication possession ratio among users.
RESULTS
Of 9827 beneficiaries with CHF and systolic dysfunction, 24.2% had a diagnosis of ADRD. Beneficiaries with ADRD were older (80.8 vs 73.6 years; P < 0.0001) and more likely to be female (69.3% vs 58.1%; P < 0.0001). Overall EBM use was lower in patients with CHF and ADRD compared with patients with CHF but no ADRD (85.3% vs 91.2%; P < 0.0001). Lower use among those with ADRD was consistent across all EBM classes except vasodilators. Among beneficiaries receiving EBM, those with ADRD had a slightly higher mean medication possession ratio for EBM compared with those without ADRD (0.86 vs 0.84; P = 0.0001).
CONCLUSIONS
EBM medication adherence was high in this population, regardless of ADRD status. However, patients with ADRD had lower EBM use compared with those without ADRD. Low use of specific EBM medications such as β-blockers was found in both groups. Therefore, interventions targeting increased treatment with specific EBMs for CHF, even among patients with ADRD, may be of benefit and could help reduce CHF-related hospitalizations.
背景
阿尔茨海默病及相关疾病（ADRD）在老年人中普遍存在，增加了慢性心力衰竭（CHF）的管理成本，并且可能与心血管疾病治疗不足有关。
目的
我们研究的目的是确定患有CHF的医疗保险受益人中ADRD共病与CHF药物使用及依从性之间的关系。
方法
这项为期2年（2006年1月1日至2007年12月31日）的横断面研究使用了医疗保险和医疗补助服务中心慢性病数据仓库的数据。纳入在整个研究期间有收缩功能障碍证据且有医疗保险A、B和D部分覆盖的CHF医疗保险受益人。使用慢性病数据仓库算法根据诊断代码识别ADRD。基于已发表的指南选择CHF循证药物（EBM）：血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、选定的β受体阻滞剂、醛固酮拮抗剂和选定的血管扩张剂。EBM的测量包括EBM使用的二元指标和使用者中的药物持有率。
结果
在9827名患有CHF和收缩功能障碍的受益人中，24.2%被诊断为ADRD。患有ADRD的受益人年龄更大（80.8岁对73.6岁；P<0.0001），且更可能为女性（69.3%对58.1%；P<0.0001）。与没有ADRD的CHF患者相比，患有CHF和ADRD的患者总体EBM使用率更低（85.3%对91.2%；P<0.0001）。除血管扩张剂外，ADRD患者在所有EBM类别中的使用率均较低。在接受EBM的受益人中，患有ADRD的人与没有ADRD的人相比，EBM的平均药物持有率略高（0.86对0.84；P=0.0001）。
结论
无论ADRD状态如何，该人群中EBM药物依从性都很高。然而，与没有ADRD的患者相比，患有ADRD的患者EBM使用率更低。两组中均发现特定EBM药物如β受体阻滞剂的使用率较低。因此，即使在患有ADRD的患者中，针对增加CHF特定EBM治疗的干预措施可能有益，并有助于减少与CHF相关的住院治疗。
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