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Impact of Non-Adherence on Renal and Cardiovascular Outcomes in US Veterans
Elvira O Gosmanova1, Miklos Z Molnar, Ahmed Alrifai
1Division of Nephrology, University of California, Irvine, Calif., USA.
Insights
A history of non-adherence, indicated by the V15.81 code, predicts worse renal and cardiovascular outcomes in hypertensive patients. This finding suggests patients with the V15.81 code need closer monitoring for better hypertension management.
Area of Science:
- Nephrology
- Cardiology
- Health Informatics
Background:
- Hypertension treatment requires adherence, but reliable non-adherence screening is lacking.
- The International Classification of Diseases 9th Edition code V15.81 for non-adherence is understudied.
- This study investigates the predictive value of the V15.81 code for adverse outcomes.
Purpose of the Study:
- To examine the association between the V15.81 code assigned before anti-hypertensive drug (AHD) initiation and renal and cardiovascular outcomes.
- To determine if a prior non-adherence code predicts future health risks in hypertensive patients.
Main Methods:
- A historical prospective cohort study of 312,489 newly treated hypertensive individuals.
- Analysis included Cox models adjusted for demographics, eGFR, BMI, blood pressure, comorbidities, and AHD adherence (PDC).
- Follow-up duration was a median of 8.0 years.
Main Results:
- The V15.81 code was associated with increased risks of faster eGFR decline, incident CKD, ESRD, incident CAD, and stroke.
- Adjusted analyses confirmed V15.81 predicted higher risks for CKD, ESRD, CAD, and stroke.
- Further adjustment for proportion of days covered (PDC) did not change these associations.
Conclusions:
- V15.81 code assignment before AHD therapy predicts worse renal and cardiovascular outcomes in hypertensive US veterans.
- A history of non-adherence (V15.81 code) is a significant prognostic marker.
- Patients with the V15.81 code may benefit from intensified monitoring, though further clinical practice recommendations require more study.
Background:
Adherence is paramount in treating hypertension; however, no gold standard method is available for non-adherence screening, delineating high-risk patients. An International Classification of Diseases 9th Edition non-adherence diagnostic code (V15.81) has been available for decades; but, its utility is poorly studied. We examined the association between the V15.81 code assigned prior to the initiation of anti-hypertensive drugs (AHDs) and renal and cardiovascular outcomes.
Methods:
This was a historical prospective cohort study involving 312,489 newly treated hypertensive individuals (mean age 53.8 years, 90.9% males, 20.3% black, median follow-up 8.0 years). We used crude and Cox models adjusted for baseline socio-demographic characteristics, estimated glomerular filtration rate (eGFR), body mass index, blood pressure, comorbidities, and prospective AHD adherence (measured as proportion of days covered, PDC).
Results:
In the unadjusted analysis, the V15.81 code was associated with higher risks for faster eGFR decline (hazard ratio, HR 1.22, 95% CI 1.11-1.33), incident CKD (HR 1.17, 95% CI 1.09-1.27), end-stage renal disease (ESRD) (HR 2.53, 95% CI 1.72-3.72), incident coronary artery disease (CAD) (HR 1.26, 95% CI 1.15-1.38), and stroke (HR 1.55, 95% CI 1.38-1.73). In the adjusted model, the V15.81 code remained predictive of increased risk of CKD (HR 1.33, 95% CI 1.22-1.45), ESRD (HR 1.81, 95% CI 1.18-2.78), incident CAD (HR 1.26, 95% CI 1.14-1.40), and stroke (HR 1.46, 95% CI 1.29-1.65). Additional adjustment for PDC did not alter adverse associations between V15.81 code and studied outcomes.
Conclusions:
Assignment of V15.81 code prior to AHD therapy was associated with higher risks of renal and cardiovascular outcomes in incident hypertensive US veterans. Previous history of non-adherence is a poor prognostic marker in hypertensive individuals; therefore, patients with V15.81 code may require close monitoring. The observational nature of this study limits our ability to make firm recommendations for clinical practice.
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