Treatment prescription, adherence, and persistence after the first hospitalization for heart failure: A population-based retrospective study on 100785 patients

Background: This study evaluates, in a real-world setting, to what extent the recommended therapies by international guidelines, are prescribed after a first hospitalization for heart failure (HF), and to analyse adherence and persistence, and the effect of treatment adherence on mortality and re-hospitalization. Methods: From the Lombardy healthcare administrative database, we analysed patients discharged after their incident HF, from 2000 to 2012. Adherence was defined as the proportion of days covered (PDC) >= 80% adjusted for hospitalizations and persistence as the absence of discontinuation of therapy for >30 days. A logit model was used to determine the effect of patients' adherence on mortality and readmissions. Results: Of 100422 HF patients (52% males, age 75 +/- 12 years), 86846 (87%) had a prescription for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers (ACE/ARBs), 64135 (64%) for beta-blockers (BB), and 36893 (37%) for mineralocorticoid receptor antagonists (MRAs), as mono-, bi- or tri-therapy. In patients on monotherapy, PDC was 78 +/- 22% for ACE/ARBs, 69 +/- 29% for BB and 54 +/- 29% for MRAs; in those on bitherapy, PDC was 63 +/- 31% for ACEI/ARBs+BB, 41 +/- 29% for ACEI/ARBs+MRAs. and 40 +/- 26% for MRAs+BB; for patients on tri-therapy, PDC was 42 +/- 28%. Medication persistence was present in 47% of patients treated with ACEI/ARBs, in 35% of patients treated with BB and in 14% of patients treated with MRAs. Re-hospitalizations and in mortality were significantly reduced in adherent patients (p < 0.000). Conclusions: Polypharmacy is associated with an increased rate of non-adherence and non-persistence in incident HF. Non-adherence is associated with an increased risk of mortality and re-hospitalizations. (C) 2021 Elsevier B.V. All rights reserved.

Automated summary

This study evaluated the prescription patterns and adherence of recommended therapies for heart failure patients after first hospitalization, finding that adherence to medication significantly reduced mortality and re-hospitalizations, highlighting the importance of medication compliance in improving outcomes for heart failure patients.