title: Transitional adherence and persistence in the use of aldosterone antagonist therapy in patients with heart failure.
abstract: BACKGROUND
  Aldosterone antagonist therapy is recommended for selected patients with heart failure and reduced ejection fraction. Adherence to therapy in the transition from hospital to home is not well understood.
  
  
  METHODS
  We identified patients with heart failure and reduced ejection fraction who were ≥65 years old, eligible for aldosterone antagonist therapy, and discharged home from hospitals in the Get With the Guidelines-Heart Failure registry between January 1, 2005, and December 31, 2008. We used Medicare prescription drug event data to measure adherence. Main outcome measures were prescription at discharge, outpatient prescription claim within 90 days, discontinuation, and adherence as measured with the medication possession ratio. We used the cumulative incidence function to estimate rates of initiation and discontinuation.
  
  
  RESULTS
  Among 2,086 eligible patients, 561 (26.9%) were prescribed an aldosterone antagonist at discharge. Within 90 days, 78.6% of eligible patients with a discharge prescription filled a prescription for the therapy, compared with 13.0% of eligible patients without a discharge prescription (P < .001). The median medication possession ratio was 0.63 over 1 year of follow-up. Among 634 patients who filled a prescription within 90 days of discharge, 7.9% discontinued therapy within 1 year.
  
  
  CONCLUSIONS
  Most eligible patients were not prescribed aldosterone antagonist therapy at discharge from a heart failure hospitalization. Eligible patients without a discharge prescription seldom initiated therapy as outpatients. Most patients who were prescribed an aldosterone antagonist at discharge filled the prescription within 90 days and remained on therapy.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC; Department of Medicine, Duke University School of Medicine, Durham, NC. Electronic address: lesley.curtis@duke.edu.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Mi
authors.forename: Laura G
authors.initials: LG
authors.lastname: Qualls
authors.forename: Devon K
authors.initials: DK
authors.lastname: Check
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Hammill
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Masoudi
authors.forename: Soko
authors.initials: S
authors.lastname: Setoguchi
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare; D055118:Medication Adherence; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use*; D012042:Registries; D012189:Retrospective Studies; D013318:Stroke Volume; D015996:Survival Rate; D014481:United States / Q000453:epidemiology
chemical_list: D000451:Mineralocorticoid Receptor Antagonists