TY - JOUR
T1 - Adherence and persistence in the use of warfarin after hospital discharge among patients with heart failure and atrial fibrillation
AU - Eapen, Zubin J.
AU - Mi, Xiaojuan
AU - Qualls, Laura G.
AU - Hammill, Bradley G.
AU - Fonarow, Gregg C.
AU - Turakhia, Mintu P.
AU - Heidenreich, Paul A.
AU - Peterson, Eric D.
AU - Curtis, Lesley H.
AU - Hernandez, Adrian F.
AU - Al-Khatib, Sana M.
N1 - Funding Information:
Funding: American Heart Association Pharmaceutical Roundtable and David and Stevie Spina; contract no. HHSA29020050032I (Duke University DECIDE Center) from the Agency for Healthcare Research and Quality, US Department of Health and Human Services , as part of the Developing Evidence to Inform Decisions About Effectiveness (DEcIDE) program; and grant no. U19HS021092 from the Agency for Healthcare Research and Quality . Dr Eapen received funding from an American Heart Association Pharmaceutical Roundtable outcomes training grant ( 0875142N ). Dr Turakhia received funding from the Veterans Health Administration . The content is solely the responsibility of the authors and does not represent the official views of the Agency for Healthcare Research and Quality.
PY - 2014/1
Y1 - 2014/1
N2 - Background Postdischarge adherence and long-term persistence in the use of warfarin among patients with heart failure and atrial fibrillation without contraindications have not been fully described. Methods and Results We identified patients with heart failure and atrial fibrillation who were ≥65 years old, eligible for warfarin, and discharged home from hospitals in the Get With the Guidelines-Heart Failure registry from January 1, 2006, to December 31, 2009. We used linked Medicare prescription drug event data to measure adherence and persistence. The main outcome measures were rates of prescription at discharge, outpatient dispensing, discontinuation, and adherence as measured by the medication possession ratio. We hypothesized that adherence to warfarin would differ according to whether patients received the prescription at discharge. Among 2,691 eligible patients, 1,856 (69.0%) were prescribed warfarin at discharge. Patients prescribed warfarin at discharge had significantly higher prescription fill rates within 90 days (84.5% vs 12.3%; P <.001) and 1 year (91.6% vs 16.8%; P <.001) and significantly higher medication possession ratios (0.78 vs 0.63; P <.001). Among both previous nonusers and existing users, fill rates at 90 days and 1 year and possession ratios were significantly higher among those prescribed warfarin at discharge. Conclusions One-third of eligible patients with heart failure and atrial fibrillation were not prescribed warfarin at discharge from a heart failure hospitalization, and few started therapy as outpatients. In contrast, most patients who were prescribed warfarin at discharge filled the prescription within 90 days and remained on therapy at 1 year.
AB - Background Postdischarge adherence and long-term persistence in the use of warfarin among patients with heart failure and atrial fibrillation without contraindications have not been fully described. Methods and Results We identified patients with heart failure and atrial fibrillation who were ≥65 years old, eligible for warfarin, and discharged home from hospitals in the Get With the Guidelines-Heart Failure registry from January 1, 2006, to December 31, 2009. We used linked Medicare prescription drug event data to measure adherence and persistence. The main outcome measures were rates of prescription at discharge, outpatient dispensing, discontinuation, and adherence as measured by the medication possession ratio. We hypothesized that adherence to warfarin would differ according to whether patients received the prescription at discharge. Among 2,691 eligible patients, 1,856 (69.0%) were prescribed warfarin at discharge. Patients prescribed warfarin at discharge had significantly higher prescription fill rates within 90 days (84.5% vs 12.3%; P <.001) and 1 year (91.6% vs 16.8%; P <.001) and significantly higher medication possession ratios (0.78 vs 0.63; P <.001). Among both previous nonusers and existing users, fill rates at 90 days and 1 year and possession ratios were significantly higher among those prescribed warfarin at discharge. Conclusions One-third of eligible patients with heart failure and atrial fibrillation were not prescribed warfarin at discharge from a heart failure hospitalization, and few started therapy as outpatients. In contrast, most patients who were prescribed warfarin at discharge filled the prescription within 90 days and remained on therapy at 1 year.
KW - Atrial fibrillation
KW - heart failure
KW - medication adherence
KW - warfarin
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U2 - 10.1016/j.cardfail.2013.11.006
DO - 10.1016/j.cardfail.2013.11.006
M3 - Article
C2 - 24275703
AN - SCOPUS:84892635547
SN - 1071-9164
VL - 20
SP - 23
EP - 30
JO - Journal of Cardiac Failure
JF - Journal of Cardiac Failure
IS - 1
ER -