Abstract 9578: Single-Item Self-Report Medication Adherence Question Predicts Hospitalization and Death in Patients with Heart Failure
Background: Sub-optimal adherence to heart failure (HF) medications contributes to worse outcomes. Having a simple means of identifying sub-optimal adherence could help identify at-risk patients for interventions.
Objective: To determine whether a single-item self-report medication adherence question predicts hospitalization and death in patients with HF.
Methods: We performed an observational study in 597 patients with HF (male 52%, age 61±13 years, NYHA III/IV 31%) within a 4-site randomized trial. Patient demographic and clinical variables were collected at baseline by interview and medical record review. Self-report medication adherence was assessed at baseline using a single item question: “Over the past 7 days, how many times did you miss a dose of any of your heart medication?” Patients who reported no missing dose were defined as adherent; those missing ≥ 1 dose were non-adherent. The primary outcome was combined all-cause hospitalization or death over 1 year; secondary endpoint was HF hospitalization. Outcomes were assessed based on blinded chart reviews and HF outcomes were determined by a blinded adjudication committee. We used negative binomial regression to examine the relationship between medication adherence and incidence of hospitalization and death, adjusting for site, demographic (age, gender, ethnicity, socioeconomic status) and clinical (HF symptoms, systolic dysfunction, β-blocker use, hypertension, and history of CVD) factors.
Results: Seventy-three percent of patients reported perfect adherence to their heart medicine at baseline. Patients with perfect medication adherence had a lower rate of events (0.71 events / year) compared with those with any non-adherence (0.90 event / year). After adjusting for site, adherent patients had an incidence rate ratio (IRR) of 0.79 (95% CI: 0.67-0.92) for all-cause hospitalization or death, and 0.79 (95% CI: 0.75-0.83) for HF hospitalization. When adding demographic and clinical factors to the model, the adjusted IRR for all-cause hospitalization and death = 0.77 (95% CI: 0.68-0.86) and for HF hospitalization = 0.83 (95% CI: 0.65-1.06).
Conclusion: A single question on medication adherence at baseline predicts hospitalization and death over 1 year in patients with HF.
- © 2011 by American Heart Association, Inc.