Abstract 19100: Medication Initiation Burden Required to Comply with Hospital Quality Measures for Heart Failure
Background: Quality measures assess whether patients discharged from the hospital with heart failure (HF) are prescribed evidence-based medical therapies. The number of new medications indicated and actually prescribed, and the related burden for patients, has not been well described.
Methods: Using data from 373 hospitals participating in Get With The Guidelines-HF registry between 2005-2013, we calculated the difference between the patient’s medication regimen at the time of admission and what would be recommended by current guidelines and quality measures at the time of discharge, as well as the number of new HF medications actually prescribed at discharge. Indications and contraindications were collected for angiotensin converting enzyme inhibitors or angiotensin receptor blockers (ACEI/ARB), beta-blockers (BB), aldosterone antagonists (AldA), hydralazine with isosorbide dinitrate (H/ISDN), and anticoagulants.
Results: Among 213,564 patients with a primary discharge diagnosis of heart failure, ACEI/ARB initiation was indicated in 18.0% of all patients (52.9% of those eligible for ACEI/ARB but not receiving it prior to admission), BB in 23.2% (57.3% of eligible), AldA in 24.6% (87.2% of eligible), H/ISDN in 9.1% (93.4% of eligible), and anticoagulant in 17.4% (56.6% of eligible). Cumulatively, 0.9% of patients were eligible for 5 new medication groups, 10.3% for 4, 18.3% for 3, 10.4% for 2, and 21.9% for 1; 38.3% were not eligible for any new medications (99.0% of whom did not have left ventricular systolic dysfunction). Compared with the number of new medications indicated (mean 1.49, SD±1.22), the number of actual new prescriptions at discharge was lower (mean 1.14, SD±0.97).
Conclusions: Among patients hospitalized with HF, the majority need to start at least one new medication and 1 in 9 patients start 4 or more medications to comply with hospital HF quality measures alone. Systems for addressing medication initiation and polypharmacy are central to HF transitional care.
Author Disclosures: L.A. Allen: Consultant/Advisory Board; Modest; J&J, Janssen, Amgen, Novartis. Employment; Significant; University of Colorado. Research Grant; Significant; NIH, NHLBI - K23, PCORI. G.C. Fonarow: Other Research Support; Significant; American Heart Association. L. Liang: Research Grant; Significant; American Heart Association. P. Schulte: Research Grant; Significant; American Heart Association. F.A. Masoudi: None. J.S. Rumsfeld: None. M. Ho: None. Z.J. Eapen: Research Grant; Significant; American Heart Association. A.F. Hernandez: Research Grant; Significant; American Heart Association. P.A. Heidenreich: None. D.L. Bhatt: Other Research Support; Significant; American Heart Association. E.D. Peterson: Research Grant; Significant; American Heart Association. H.M. Krumholz: Research Grant; Significant; Medtronic, Johnson and Johnson. Consultant/Advisory Board; Significant; United Health Care.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.