Initiation, Adherence, and Persistence to Guideline-Directed Medical Therapy After Heart Failure Hospitalization

Area of Science:

• Cardiology
• Pharmacology
• Health Services Research

Background:

• Guideline-directed medical therapy (GDMT) is crucial for improving heart failure (HF) outcomes.
• Sustained medication use after HF hospitalization is not well understood.
• Prescription patterns post-discharge significantly impact long-term patient management.

Purpose of the Study:

• To characterize medication-use patterns following HF hospitalizations.
• To assess the initiation, adherence, and persistence of new HF medications prescribed at discharge.
• To identify gaps in sustained medication use after hospital discharge.

Main Methods:

• A cohort study analyzed electronic health records and pharmacy dispensation data for 6111 patients discharged after HF hospitalization.
• Medication initiation, primary nonadherence, adherence (proportion of days covered ≥80%), and persistence were assessed over 6 months.
• Key HF medications included β-blockers, RAS inhibitors, MRAs, and SGLT2 inhibitors.

Main Results:

• 51% of patients received at least one new HF medication at discharge.
• Primary nonadherence ranged from 35% (SGLT2is) to 51% (β-blockers).
• At 6 months, only 42% of patients were adherent and 51% persistent to all prescribed HF medications.

Conclusions:

• A significant proportion of guideline-directed medical therapy prescriptions for HF are not filled or sustained post-discharge.
• This highlights a critical need for interventions to improve medication adherence and persistence.
• Optimizing medication use is essential for improving long-term heart failure outcomes.