Variation in Medication Adherence in Heart Failure

JAMA Internal Medicine (Impact Factor: 13.12). 02/2013; 173(6):1-2. DOI: 10.1001/jamainternmed.2013.2509
Source: PubMed
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    ABSTRACT: Medicare Part D has had important implications for patient outcomes and treatment costs among beneficiaries with congestive heart failure (CHF). This study finds that improved medication adherence associated with expansion of drug coverage under Part D led to nearly $2.6 billion in reductions in medical expenditures annually among beneficiaries diagnosed with CHF and without prior comprehensive drug coverage, of which over $2.3 billion was savings to Medicare. Further improvements in adherence could potentially save Medicare another $1.9 billion annually, generating upwards of $22.4 billion in federal savings over 10 years.
    The American journal of managed care 05/2013; 19(6 Suppl):s97-s100. · 2.26 Impact Factor
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    ABSTRACT: Hospitalizations for heart failure (HF) are increasing, and HF is the primary cause of readmission for all Medicare patients. Inpatient HF mortality is poor, but most morbidity and mortality occurs after hospital discharge. Readmissions attributable to HF persist or increase over time after discharge, and past HF admissions predict both readmission and mortality. The heightened risk of readmission dissipates slowly after discharge, suggesting that any intervention should be part of a lasting care package in the outpatient setting. Interventions that apply to multiple common medical comorbidities may be more likely to reduce overall adverse events.
    Heart Failure Clinics 07/2013; 9(3):303-20. DOI:10.1016/j.hfc.2013.04.005 · 1.84 Impact Factor
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    ABSTRACT: Recent and national data on adherence to heart failure drugs are limited, particularly among the disabled and some small minority groups, such as Native Americans and Hispanics. We compare medication adherence among Medicare patients with heart failure, by disability status, race/ethnicity, and income. Observational study. US Medicare Parts A, B, and D data, 5 % random sample, 2007-2009. 149,893 elderly Medicare beneficiaries and 21,204 disabled non-elderly beneficiaries. We examined 5 % of Medicare fee-for-service beneficiaries with heart failure in 2007-2009. The main outcome was 1-year adherence to one of three therapeutic classes: β-blockers, diuretics, and angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin II receptor blockers (ARBs). Adherence was defined as having prescriptions in possession for ≥ 75 % of days. Among aged beneficiaries, 1-year adherences to at least one heart failure drug were 63 %, 57 %, 53 %, 50 %, and 52 % for Whites, Asians, Hispanics, Native Americans and Blacks, respectively; among the disabled, 1-year adherence was worse for each group: 57 %, 53 %, 48 %, 44 % and 43 % respectively. The racial/ethnic difference persisted after adjustment for age, gender, income, drug coverage, location and health status. Patterns of adherence were similar among beneficiaries on all three therapeutic classes. Among beneficiaries with close-to-full drug coverage, minorities were still less likely to adhere relative to Whites, OR = 0.61 (95 % CI 0.58-0.64) for Hispanics, OR = 0.59 (95 % CI 0.57-0.62) for Blacks and OR = 0.57 (95 % CI 0.47-0.68) for Native Americans. After the implementation of Medicare Part D, adherence to heart failure drugs remains problematic, especially among disabled and minority beneficiaries, including Native Americans, Blacks, and Hispanics. Even among those with close-to-full drug coverage, racial differences remain, suggesting that policies simply relying on cost reduction cannot eliminate racial differences.
    Journal of General Internal Medicine 12/2013; 29(4). DOI:10.1007/s11606-013-2692-x · 3.42 Impact Factor
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