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Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures.

Publication ,  Journal Article
Allen, LA; Fonarow, GC; Liang, L; Schulte, PJ; Masoudi, FA; Rumsfeld, JS; Ho, PM; Eapen, ZJ; Hernandez, AF; Heidenreich, PA; Bhatt, DL ...
Published in: Circulation
October 6, 2015

BACKGROUND: Guidelines for heart failure (HF) recommend prescription of guideline-directed medical therapy before hospital discharge; some of these therapies are included in publicly reported performance measures. The burden of new medications for individual patients has not been described. METHODS AND RESULTS: We used Get With The Guidelines-HF registry data from 2008 to 2013 to characterize prescribing, indications, and contraindications for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, β-blockers, aldosterone antagonists, hydralazine/isosorbide dinitrate, and anticoagulants. The difference between a patient's medication regimen at hospital admission and that recommended by HF quality measures at discharge was calculated. Among 158 922 patients from 271 hospitals with a primary discharge diagnosis of HF, initiation of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers was indicated in 18.1% of all patients (55.5% of those eligible at discharge were not receiving angiotensin-converting enzyme inhibitors or angiotensin receptor blockers at admission), β-blockers in 20.3% (50.5% of eligible), aldosterone antagonists in 24.1% (87.4% of eligible), hydralazine/isosorbide dinitrate in 8.6% (93.1% of eligible), and anticoagulants in 18.0% (58.0% of eligible). Cumulatively, 0.4% of patients were eligible for 5 new medication groups, 4.1% for 4 new medication groups, 9.4% for 3 new medication groups, 10.1% for 2 new medication groups, and 22.7% for 1 new medication group; 15.0% were not eligible for new medications because of adequate prescribing at admission; and 38.4% were not eligible for any medications recommended by HF quality measures. Compared with newly indicated medications (mean, 1.45 ± 1.23), actual new prescriptions were lower (mean, 1.16 ± 1.00). CONCLUSIONS: A quarter of patients hospitalized with HF need to start >1 medication to meet HF quality measures. Systems for addressing medication initiation and managing polypharmacy are central to HF transitional care.

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Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 6, 2015

Volume

132

Issue

14

Start / End Page

1347 / 1353

Location

United States

Related Subject Headings

  • Quality Assurance, Health Care
  • Practice Guidelines as Topic
  • Polypharmacy
  • Patient Discharge
  • Patient Admission
  • Middle Aged
  • Medication Adherence
  • Male
  • Humans
  • Hospitals
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Allen, L. A., Fonarow, G. C., Liang, L., Schulte, P. J., Masoudi, F. A., Rumsfeld, J. S., … American Heart Association’s Get With The Guidelines Heart Failure (GWTG-HF) Investigators, . (2015). Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures. Circulation, 132(14), 1347–1353. https://doi.org/10.1161/CIRCULATIONAHA.115.014281
Allen, Larry A., Gregg C. Fonarow, Li Liang, Phillip J. Schulte, Frederick A. Masoudi, John S. Rumsfeld, P Michael Ho, et al. “Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures.Circulation 132, no. 14 (October 6, 2015): 1347–53. https://doi.org/10.1161/CIRCULATIONAHA.115.014281.
Allen LA, Fonarow GC, Liang L, Schulte PJ, Masoudi FA, Rumsfeld JS, et al. Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures. Circulation. 2015 Oct 6;132(14):1347–53.
Allen, Larry A., et al. “Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures.Circulation, vol. 132, no. 14, Oct. 2015, pp. 1347–53. Pubmed, doi:10.1161/CIRCULATIONAHA.115.014281.
Allen LA, Fonarow GC, Liang L, Schulte PJ, Masoudi FA, Rumsfeld JS, Ho PM, Eapen ZJ, Hernandez AF, Heidenreich PA, Bhatt DL, Peterson ED, Krumholz HM, American Heart Association’s Get With The Guidelines Heart Failure (GWTG-HF) Investigators. Medication Initiation Burden Required to Comply With Heart Failure Guideline Recommendations and Hospital Quality Measures. Circulation. 2015 Oct 6;132(14):1347–1353.

Published In

Circulation

DOI

EISSN

1524-4539

Publication Date

October 6, 2015

Volume

132

Issue

14

Start / End Page

1347 / 1353

Location

United States

Related Subject Headings

  • Quality Assurance, Health Care
  • Practice Guidelines as Topic
  • Polypharmacy
  • Patient Discharge
  • Patient Admission
  • Middle Aged
  • Medication Adherence
  • Male
  • Humans
  • Hospitals