Beatrice A Marzluf1, Berthold Reichardt2, Lisa M Neuhofer3, Bernhard Kogler4, Michael Wolzt1. 1. Department of Clinical Pharmacology, Medical University of Vienna, Vienna, Austria. 2. Provincial Sickness Fund Burgenland, Eisenstadt, Austria. 3. Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria. 4. Main Association of Austrian Social Security Institutions, Vienna, Austria.
Abstract
PURPOSE: Guideline-recommended therapy has been proven beneficial in heart failure (HF), but general implementation remains poor. The aim of this study was to evaluate the adherence to drug therapy, quality of primary non-drug medical care (NDMC) and its impact on HF outcome. METHODS: From 13 Austrian health insurance funds, we identified 36 829 patients (77.1 ± 10.8 years, 44.8% men) hospitalised for HF who survived more than 90 days after discharge in the period between April 2006 and June 2010. Drug adherence was analysed from prescriptions filled and NDMC from numbers of physician consultations and diagnostic tests relevant for HF per quarter of a year (medical care index (MedCI)) claimed from the insurance funds. Kaplan-Meier and multivariate Cox regression analyses were performed to identify the association of outcome (survival and death without further admission for HF, readmission for HF) with drug adherence and NDMC. RESULTS: Readmission due to HF or death without prior readmission for HF occurred in 19.7% and 22.5%, respectively. Adherence to angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, beta-blockers and aldosterone antagonists was 49.3%, 40.4% and 16.1%, respectively, and was associated with better survival by Kaplan-Meier analysis. NDMC was consumed less frequently by deceased (76.0%; MedCI 2.55 ± 3.04) than surviving (79.3%; 3.60 ± 3.81) or readmitted (78.4%; 3.80 ± 4.13) patients (p < 0.001 for deceased vs both other). Drug adherence and NDMC were independent factors associated with better survival by multivariate regression analysis. CONCLUSION: Guideline-recommended drug therapy remains underutilised in Austria. Drug adherence and quality of NDMC are associated with better outcome in HF patients.
PURPOSE: Guideline-recommended therapy has been proven beneficial in heart failure (HF), but general implementation remains poor. The aim of this study was to evaluate the adherence to drug therapy, quality of primary non-drug medical care (NDMC) and its impact on HF outcome. METHODS: From 13 Austrian health insurance funds, we identified 36 829 patients (77.1 ± 10.8 years, 44.8% men) hospitalised for HF who survived more than 90 days after discharge in the period between April 2006 and June 2010. Drug adherence was analysed from prescriptions filled and NDMC from numbers of physician consultations and diagnostic tests relevant for HF per quarter of a year (medical care index (MedCI)) claimed from the insurance funds. Kaplan-Meier and multivariate Cox regression analyses were performed to identify the association of outcome (survival and death without further admission for HF, readmission for HF) with drug adherence and NDMC. RESULTS: Readmission due to HF or death without prior readmission for HF occurred in 19.7% and 22.5%, respectively. Adherence to angiotensin-converting-enzyme inhibitors or angiotensin receptor blockers, beta-blockers and aldosterone antagonists was 49.3%, 40.4% and 16.1%, respectively, and was associated with better survival by Kaplan-Meier analysis. NDMC was consumed less frequently by deceased (76.0%; MedCI 2.55 ± 3.04) than surviving (79.3%; 3.60 ± 3.81) or readmitted (78.4%; 3.80 ± 4.13) patients (p < 0.001 for deceased vs both other). Drug adherence and NDMC were independent factors associated with better survival by multivariate regression analysis. CONCLUSION: Guideline-recommended drug therapy remains underutilised in Austria. Drug adherence and quality of NDMC are associated with better outcome in HF patients.
Authors: Seyed Hamidreza Mahmoudpour; Folkert W Asselbergs; Patrick C Souverein; Anthonius de Boer; Anke H Maitland-van der Zee Journal: Br J Clin Pharmacol Date: 2018-07-24 Impact factor: 4.335
Authors: Rizwan Zafar; Muhammad Haris; Salman Assad; Muhammad Usman Shabbir; Haider Ghazanfar; Sarah A Malik; Tehreem Khalid; Ali H Abbas; Asad A Saleem Journal: Cureus Date: 2016-08-08
Authors: Alessandra Buja; Giuliana Solinas; Modesta Visca; Bruno Federico; Rosa Gini; Vincenzo Baldo; Paolo Francesconi; Gino Sartor; Mariadonata Bellentani; Gianfranco Damiani Journal: Int J Environ Res Public Health Date: 2016-02-19 Impact factor: 3.390
Authors: Raphael Wurm; Martin Huelsmann; Marius Hienert; Veronika Seidl; Dominik Wiedemann; Guenther Laufer; Alfred Kocher; Christopher Adlbrecht; Martin Andreas Journal: Sci Rep Date: 2017-11-02 Impact factor: 4.379