Lu Lingyun, Jackevicius Cynthia A, de Leon Noelle K, Warner Alberta L, Chang Donald S, Mody Freny Vaghaiwalla
VA Greater Los Angeles Healthcare System, Los Angeles, California.
VA Greater Los Angeles Healthcare System, Los Angeles, California; Western University of Health Sciences, Pomona, California; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.
Clin Ther. 2017 Jun;39(6):1200-1209. doi: 10.1016/j.clinthera.2017.04.012. Epub 2017 May 22.
Disease management programs have been associated with improved adherence to heart failure (HF) medications. However, there remain limited data on the benefit of a comprehensive multidisciplinary HF postdischarge management (PDM) clinic that promptly follows HF-related hospitalization on evidence-based HF medication adherence.
The aim of this study was to evaluate the effects of an HF-PDM clinic on adherence to evidence-based HF medication therapy.
In this retrospective cohort study, we identified patients discharged from the Veterans Affairs Greater Los Angeles Healthcare System between 2009 and 2012 with a primary diagnosis of HF. Data from patients who attended the HF-PDM clinic immediately following HF-related hospitalization between 2010 and 2012 were compared with those from historical controls, who did not attend the HF-PDM clinic, from 2009. The main outcome was adherence to evidence-based HF medications during the 90 days after discharge. Adherence was defined as the proportion of days covered at 90 days after discharge (PDC-90) of ≥0.80. The percentages of patients adherent to each medication were compared between the 2 groups using the χ test. A logistic regression model adjusted for potential confounding variables was constructed to evaluate the percentages of patients adherent to evidence-based HF medications.
A total of 277 patients (144 clinic, 133 control) were included in the study. 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) versus 0.93 (clinic) (P = 0.008) and 90-day adherence rates of 69% (control) versus 87% (clinic) (P = 0.005).
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.
疾病管理项目已与改善心力衰竭（HF）药物依从性相关联。然而，关于在心力衰竭相关住院后迅速开展的全面多学科心力衰竭出院后管理（PDM）诊所对基于证据的心力衰竭药物依从性的益处，数据仍然有限。
本研究的目的是评估心力衰竭-PDM诊所对基于证据的心力衰竭药物治疗依从性的影响。
在这项回顾性队列研究中，我们确定了2009年至2012年间从退伍军人事务大洛杉矶医疗保健系统出院的主要诊断为心力衰竭的患者。将2010年至2012年间因心力衰竭相关住院后立即参加心力衰竭-PDM诊所的患者数据与2009年未参加心力衰竭-PDM诊所的历史对照患者数据进行比较。主要结局是出院后90天内对基于证据的心力衰竭药物的依从性。依从性定义为出院后90天覆盖天数比例（PDC-90）≥0.80。使用χ检验比较两组中每种药物依从性患者的百分比。构建了一个针对潜在混杂变量进行调整的逻辑回归模型，以评估基于证据的心力衰竭药物依从性患者的百分比。
共有277名患者（144名诊所患者，133名对照患者）纳入研究。单因素和多因素分析均显示，与对照组相比，该诊所与血管紧张素转换酶抑制剂、每日两次β受体阻滞剂和醛固酮拮抗剂的药物依从性改善相关。依从性增加最显著的是血管紧张素转换酶抑制剂，平均PDC-90值为0.84（对照组）对0.93（诊所组）（P = 0.008），90天依从率为69%（对照组）对87%（诊所组）（P = 0.005）。
在多学科心力衰竭-PDM诊所接受治疗与心力衰竭相关住院后近期出院患者90天内对基于证据的心力衰竭药物依从性显著提高相关。
