Causes and Consequences of Nonpersistence With Heart Failure Medication

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• 作者：Mary Mockler ; Christina O'Loughlin ; Niamh Murphy ; Mary Ryder ; Carmel Conlon ; Kenneth Michael McDonald ; Mark Thomas Ledwidge
• 刊名：The American Journal of Cardiology
• 出版年：2009
• 出版时间：15 March 2009
• 年：2009
• 卷：103
• 期：6
• 页码：834-838
• 全文大小：161 K

文摘

Persistence with therapy may be more easily and objectively identified in the clinical setting than compliance and recent work has shown it to be linked to mortality in heart failure (HF). The aim of this study was to determine the extent, causes, and clinical impact of nonpersistence with disease-modifying therapy in a retrospective cohort study of 183 patients with systolic HF participating in a disease management program. The main outcome measurements were reasons/determinants of nonpersistence and its impact on hospitalizations. Fifty-three patients (29 % ) had 74 separate occurrences of nonpersistence with disease-modifying therapy. There was no medical reason for discontinuing medications in 50 % of occurrences, whereas medication was discontinued for an adverse reaction in 30 % and for a justified medical reason in 15 % of occurrences. Nonpersistence was a significant predictor of all-cause readmission (hazard ratio 3.20, 95 % confidence interval 1.74 to 11.37) and cardiovascular readmission (hazard ratio 4.45, 95 % confidence interval 1.74 to 11.37). In the adjusted model, there was no significantly increased risk of HF readmission (hazard ratio 2.41, 95 % confidence interval 0.88 to 6.62). In conclusion, nonpersistence with HF therapy is common, is often not medically justified, and is associated with an increased risk of hospitalization.