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Adherence, Hospitalizations and Treatment Modifications Among Heart Failure Patients: A Retrospective US Claims Database Analysis
Abstracts / Heart & Lung 45 (2016) 372e376
and problem-solving of group-initiated concerns. Repeated measures were collected during the follow-up period. Results: The standard care and intervention groups were equivalent on demographic and severity of illness variables (Charlson Comorbidity scores). The group clinic intervention was associated with greater adherence to recommended vasodilator medications (P¼0.04). During the study period, 22 (24%) patients in the intervention group and 30 (28%) patients in standard care group died or had a heart failure hospitalization. Total heart failure-related hospitalizations, including repeat hospitalizations after the first hospitalization were 28 and 45 in the intervention group and in the standard care group, respectively. Effects of the intervention on rehospitalization varied significantly over time. From 2 to 7 months post-randomization, there was a significantly longer hospitalization-free time in the intervention group, compared to the standard care group (Cox proportional hazard ratio¼0.45 (95% confidence interval, 0.21e0.98; P¼0.04). No significant difference between groups was found from month 8 to month 12 (hazard ratio¼1.7; 95% confidence interval, 0.7e4.1). Conclusion: Multidisciplinary group clinic appointments were associated with greater adherence to selected medications used in the treatment of heart failure and longer hospitalization-free survival during the time of the treatment intervention. Larger studies are needed to confirm the benefits found in this clinical trial and to identify methods to sustain these benefits.
4 Mortality and Heart Failure Readmission: The benefits of participating in a rural integrated delivery system heart failure program CARL EDWARD HELTNE, COLLEEN M. RENIER, LINDA L. WICK, MICHAEL E. MOLLERUS Purpose: Mortality and readmission remain concerns in treatment of patients hospitalized for congestive heart failure. This study was undertaken to better understand survival and heart failure readmission associated with rural integrated delivery system (IDS) heart failure disease management program participation. Background: Mortality and hospital readmission remain concerns in treatment of patients hospitalized for congestive heart failure (CHF). Suter et al. reported the 30-day post-admission median riskstandardized mortality rate for patients 65 years of age or older was 11.3% (range 6.4-17.9) and the median 30-day post-discharge riskstandardized readmission rate was 22.9 (range 17.1-30.7). Rural patients have been shown to have higher rates of mortality and hospitalization than their urban counterparts. Methods: This retrospective study reviewed all adult patients presenting to the tertiary hospital of a rural IDS with decompensated congestive heart failure (DRG #’s 127, 291-293) over a five year period, beginning with their first discharge. The primary endpoint was survival at 30 and 60 days. The secondary endpoint was heart failure readmissions at 30 days (DRGs 127, 291-293 and ICD-9 Codes 398.91, 413.9, 428.0-428.9, 458.0, 780.2, 786.05, 786.09, 786.50, and 786.59). A comparison population was established by utilizing logistic regression to calculate a propensity score. Heart Failure Disease Management Program (HFDMP) and nonHeart Failure Disease Management Program (non-HFDMP) patients were matched one-to-one into sets based on their propensity scores +/- 0.03 (3%), using a greedy matching algorithm. Analyses were conducted on the propensity matched HFDMP/non-HFDMP sets of data. Descriptive analyses of demographic and health characteristics and treatment characteristics were conducted using the Wald chi-square test. Generalized estimating equations assessed survival and readmission. All readmission analysis was weighted by weeks of period survived. Statistically significant difference was defined as a two-tailed p-value < 0.05.
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Results: There were 264 matched sets of HFDMP/non-HFDMP patients. No demographic differences were identified, with approximately 40% female, 80% 65 years of age or over, 39% rural residing and 67% past or present smokers. There were also no significant differences found in the following comorbidities: diabetes mellitus, hypertension, hyperlipidemia, peripheral vascular disease, atrial fibrillation, chronic obstructive pulmonary disease, coronary artery disease, and renal function. After adjusting for significant covariates, the mortality rates for the non-HFDMP and HFDMP patients were 7.5% and 2.7% , O.R. 3.0 [1.3, 6.8], and 9.2% and 4.1% , O.R. 2.4 [1.3, 4.5], at 30 and 60 days, respectively. Similarly, the adjusted 30-day readmission rates for non-HFDMP and HFDMP were 11.4% and 3.0%, respectively, O.R. 4.1 [1.9, 8.9]. Conclusion: A Survival advantage was demonstrated at 30 and 60 days. This was coupled with a reduced 30 day readmission rate for heart failure for those patients in the Heart Failure Disease Management Program. 5 Adherence, Hospitalizations and Treatment Modifications Among Heart Failure Patients: A Retrospective US Claims Database Analysis CELINE DESCHASEAUX, MARTIN MCSHARRY, EIBHLIN HUDSON, STUART J. TURNER Purpose: To understand the real world treatment transition pattern post hospitalization in heart failure (HF) patients and the associated adherence/persistence with their HF-related medications. Background: HF is the most common reason for hospitalization among Medicare beneficiaries. This study evaluates hospitalization, subsequent treatment modifications post hospitalization and treatment adherence (for angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blocker (BB) and aldosterone antagonists (AA)) among HF patients recently diagnosed in a real world setting in the US. Methods: Using administrative claims data from the Truven MarketScan database, this retrospective cohort study included adult patients with 2 HF-related medical claims between April 2009 and March 2012 and with a minimum of 12 months pre-and postindex continuous medical and pharmacy eligibility. Index date was defined as the first HF-related medical claim between April 2009 and March 2012. Patients with a HF diagnosis in the 12 months preindex period were excluded. All-cause and HF-related hospitalization, length of stay (LOS), change in treatment pattern post HF hospitalization (15-day period), treatment adherence [medication possession ratio (MPR), proportion of days covered (PDC)] and persistence rate over 12 months was determined. Results: 235,758 recently diagnosed patients with a median follow-up of 28 months were included in the analysis. A total of 74% patients had at least one allcause hospitalization, with a mean of 1.11 (SD: 0.98) per year and LOS of 7.19 (8.69) days. Corresponding values for HF hospitalization were 21.9%, 0.18 (0.36) per year and 5.85 (5.45) days, respectively. Post first HF hospitalization, more patients on dual and triple therapy remained on the same treatment (73-88%) compared to those patients treated with monotherapy (60-73%). Among patients on ACEI and BB monotherapy, 21% and 17% transitioned to ACEI+BB combination. Of patients on ACEI+BB, 9% transitioned to ACEI+BB+AA. Of the untreated patients, 17% received treatment post HF hospitalization. The median MPR and PDC were >0.93 (range: 0.03-1.00) and >0.65 (>0 - 1), respectively. Considering a gap period of 30 days, persistence ranged between 41% (AA) to 52% (BB). Conclusion: Study results suggest that the treatment for HF patients does not change substantially post HF hospitalization. Overall, HF patients showed good adherence and moderate persistence to the treatment.
and problem-solving of group-initiated concerns. Repeated measures were collected during the follow-up period. Results: The standard care and intervention groups were equivalent on demographic and severity of illness variables (Charlson Comorbidity scores). The group clinic intervention was associated with greater adherence to recommended vasodilator medications (P¼0.04). During the study period, 22 (24%) patients in the intervention group and 30 (28%) patients in standard care group died or had a heart failure hospitalization. Total heart failure-related hospitalizations, including repeat hospitalizations after the first hospitalization were 28 and 45 in the intervention group and in the standard care group, respectively. Effects of the intervention on rehospitalization varied significantly over time. From 2 to 7 months post-randomization, there was a significantly longer hospitalization-free time in the intervention group, compared to the standard care group (Cox proportional hazard ratio¼0.45 (95% confidence interval, 0.21e0.98; P¼0.04). No significant difference between groups was found from month 8 to month 12 (hazard ratio¼1.7; 95% confidence interval, 0.7e4.1). Conclusion: Multidisciplinary group clinic appointments were associated with greater adherence to selected medications used in the treatment of heart failure and longer hospitalization-free survival during the time of the treatment intervention. Larger studies are needed to confirm the benefits found in this clinical trial and to identify methods to sustain these benefits.
4 Mortality and Heart Failure Readmission: The benefits of participating in a rural integrated delivery system heart failure program CARL EDWARD HELTNE, COLLEEN M. RENIER, LINDA L. WICK, MICHAEL E. MOLLERUS Purpose: Mortality and readmission remain concerns in treatment of patients hospitalized for congestive heart failure. This study was undertaken to better understand survival and heart failure readmission associated with rural integrated delivery system (IDS) heart failure disease management program participation. Background: Mortality and hospital readmission remain concerns in treatment of patients hospitalized for congestive heart failure (CHF). Suter et al. reported the 30-day post-admission median riskstandardized mortality rate for patients 65 years of age or older was 11.3% (range 6.4-17.9) and the median 30-day post-discharge riskstandardized readmission rate was 22.9 (range 17.1-30.7). Rural patients have been shown to have higher rates of mortality and hospitalization than their urban counterparts. Methods: This retrospective study reviewed all adult patients presenting to the tertiary hospital of a rural IDS with decompensated congestive heart failure (DRG #’s 127, 291-293) over a five year period, beginning with their first discharge. The primary endpoint was survival at 30 and 60 days. The secondary endpoint was heart failure readmissions at 30 days (DRGs 127, 291-293 and ICD-9 Codes 398.91, 413.9, 428.0-428.9, 458.0, 780.2, 786.05, 786.09, 786.50, and 786.59). A comparison population was established by utilizing logistic regression to calculate a propensity score. Heart Failure Disease Management Program (HFDMP) and nonHeart Failure Disease Management Program (non-HFDMP) patients were matched one-to-one into sets based on their propensity scores +/- 0.03 (3%), using a greedy matching algorithm. Analyses were conducted on the propensity matched HFDMP/non-HFDMP sets of data. Descriptive analyses of demographic and health characteristics and treatment characteristics were conducted using the Wald chi-square test. Generalized estimating equations assessed survival and readmission. All readmission analysis was weighted by weeks of period survived. Statistically significant difference was defined as a two-tailed p-value < 0.05.
373
Results: There were 264 matched sets of HFDMP/non-HFDMP patients. No demographic differences were identified, with approximately 40% female, 80% 65 years of age or over, 39% rural residing and 67% past or present smokers. There were also no significant differences found in the following comorbidities: diabetes mellitus, hypertension, hyperlipidemia, peripheral vascular disease, atrial fibrillation, chronic obstructive pulmonary disease, coronary artery disease, and renal function. After adjusting for significant covariates, the mortality rates for the non-HFDMP and HFDMP patients were 7.5% and 2.7% , O.R. 3.0 [1.3, 6.8], and 9.2% and 4.1% , O.R. 2.4 [1.3, 4.5], at 30 and 60 days, respectively. Similarly, the adjusted 30-day readmission rates for non-HFDMP and HFDMP were 11.4% and 3.0%, respectively, O.R. 4.1 [1.9, 8.9]. Conclusion: A Survival advantage was demonstrated at 30 and 60 days. This was coupled with a reduced 30 day readmission rate for heart failure for those patients in the Heart Failure Disease Management Program. 5 Adherence, Hospitalizations and Treatment Modifications Among Heart Failure Patients: A Retrospective US Claims Database Analysis CELINE DESCHASEAUX, MARTIN MCSHARRY, EIBHLIN HUDSON, STUART J. TURNER Purpose: To understand the real world treatment transition pattern post hospitalization in heart failure (HF) patients and the associated adherence/persistence with their HF-related medications. Background: HF is the most common reason for hospitalization among Medicare beneficiaries. This study evaluates hospitalization, subsequent treatment modifications post hospitalization and treatment adherence (for angiotensin converting enzyme inhibitor (ACEI), angiotensin receptor blocker (ARB), beta-blocker (BB) and aldosterone antagonists (AA)) among HF patients recently diagnosed in a real world setting in the US. Methods: Using administrative claims data from the Truven MarketScan database, this retrospective cohort study included adult patients with 2 HF-related medical claims between April 2009 and March 2012 and with a minimum of 12 months pre-and postindex continuous medical and pharmacy eligibility. Index date was defined as the first HF-related medical claim between April 2009 and March 2012. Patients with a HF diagnosis in the 12 months preindex period were excluded. All-cause and HF-related hospitalization, length of stay (LOS), change in treatment pattern post HF hospitalization (15-day period), treatment adherence [medication possession ratio (MPR), proportion of days covered (PDC)] and persistence rate over 12 months was determined. Results: 235,758 recently diagnosed patients with a median follow-up of 28 months were included in the analysis. A total of 74% patients had at least one allcause hospitalization, with a mean of 1.11 (SD: 0.98) per year and LOS of 7.19 (8.69) days. Corresponding values for HF hospitalization were 21.9%, 0.18 (0.36) per year and 5.85 (5.45) days, respectively. Post first HF hospitalization, more patients on dual and triple therapy remained on the same treatment (73-88%) compared to those patients treated with monotherapy (60-73%). Among patients on ACEI and BB monotherapy, 21% and 17% transitioned to ACEI+BB combination. Of patients on ACEI+BB, 9% transitioned to ACEI+BB+AA. Of the untreated patients, 17% received treatment post HF hospitalization. The median MPR and PDC were >0.93 (range: 0.03-1.00) and >0.65 (>0 - 1), respectively. Considering a gap period of 30 days, persistence ranged between 41% (AA) to 52% (BB). Conclusion: Study results suggest that the treatment for HF patients does not change substantially post HF hospitalization. Overall, HF patients showed good adherence and moderate persistence to the treatment.