title: Association between adherence to diuretic therapy and health care utilization in patients with heart failure.
abstract: OBJECTIVE
  To determine the relationship between adherence to diuretic therapy and health care utilization.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  University-affiliated medical center.
  
  
  METHODS
  Forty-two patients with heart failure.
  
  
  METHODS
  Electronic monitoring of adherence to diuretic therapy (percentage of diuretic prescription container openings) and to scheduling (percentage of container openings within a specific time).
  
  
  RESULTS
  All patients were prescribed a diuretic, most commonly furosemide (88%). Patients varied widely in adherence to therapy (mu = 72% +/- 30%) and to scheduling (mu = 43% +/- 30%). Education was a predictor of drug-taking adherence (p=0.0062) but not of scheduling adherence. Log-linear models revealed that poor scheduling adherence was associated with increased cardiovascular-related hospitalizations (chi2 11.63, p=0.0006) and predicted more heart failure-related hospitalizations (chi2 4.04, p=0.0444). In contrast, neither measure was significantly associated with cardiovascular- or heart failure-related emergency department visits. We found a moderate correlation between scheduling adherence and taking adherence (r = 0.6513).
  
  
  CONCLUSIONS
  Patients taking a greater proportion of diuretic agents on schedule may decrease the risk of cardiovascular- and heart failure-related hospitalizations. If these findings are confirmed by a larger study, interventions to improve adherence and patient health outcomes should consider the timing of doses as well as the number of daily doses of a diuretic.
authors.affiliation: Midwestern University College of Pharmacy-Glendale, Glendale, Arizona, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Chui
authors.forename: Melissa
authors.initials: M
authors.lastname: Deer
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Bennett
authors.forename: Wanzhu
authors.initials: W
authors.lastname: Tu
authors.forename: Stacey
authors.initials: S
authors.lastname: Oury
authors.forename: D Craig
authors.initials: DC
authors.lastname: Brater
authors.forename: Michael D
authors.initials: MD
authors.lastname: Murray
mesh_terms: D004232:Diuretics / Q000627:therapeutic use*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006333:Heart Failure / Q000188:drug therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011446:Prospective Studies
chemical_list: D004232:Diuretics