title: Adherence and persistence in the use of warfarin after hospital discharge among patients with heart failure and atrial fibrillation.
abstract: BACKGROUND
  Postdischarge adherence and long-term persistence in the use of warfarin among patients with heart failure and atrial fibrillation without contraindications have not been fully described.
  
  
  RESULTS
  We identified patients with heart failure and atrial fibrillation who were ≥ 65 years old, eligible for warfarin, and discharged home from hospitals in the Get With the Guidelines-Heart Failure registry from January 1, 2006, to December 31, 2009. We used linked Medicare prescription drug event data to measure adherence and persistence. The main outcome measures were rates of prescription at discharge, outpatient dispensing, discontinuation, and adherence as measured by the medication possession ratio. We hypothesized that adherence to warfarin would differ according to whether patients received the prescription at discharge. Among 2,691 eligible patients, 1,856 (69.0%) were prescribed warfarin at discharge. Patients prescribed warfarin at discharge had significantly higher prescription fill rates within 90 days (84.5% vs 12.3%; P < .001) and 1 year (91.6% vs 16.8%; P < .001) and significantly higher medication possession ratios (0.78 vs 0.63; P < .001). Among both previous nonusers and existing users, fill rates at 90 days and 1 year and possession ratios were significantly higher among those prescribed warfarin at discharge.
  
  
  CONCLUSIONS
  One-third of eligible patients with heart failure and atrial fibrillation were not prescribed warfarin at discharge from a heart failure hospitalization, and few started therapy as outpatients. In contrast, most patients who were prescribed warfarin at discharge filled the prescription within 90 days and remained on therapy at 1 year.
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina. Electronic address: zubin.eapen@duke.edu.
authors.forename: Zubin J
authors.initials: ZJ
authors.lastname: Eapen
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Xiaojuan
authors.initials: X
authors.lastname: Mi
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Laura G
authors.initials: LG
authors.lastname: Qualls
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Bradley G
authors.initials: BG
authors.lastname: Hammill
authors.affiliation: Ahmanson-UCLA Cardiomyopathy Center, University of California, Los Angeles, California.
authors.forename: Gregg C
authors.initials: GC
authors.lastname: Fonarow
authors.affiliation: Veterans Administration Palo Alto Health Care System, Palo Alto, California; Department of Medicine, Stanford University, Palo Alto, California.
authors.forename: Mintu P
authors.initials: MP
authors.lastname: Turakhia
authors.affiliation: Veterans Administration Palo Alto Health Care System, Palo Alto, California; Department of Medicine, Stanford University, Palo Alto, California.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Lesley H
authors.initials: LH
authors.lastname: Curtis
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina; Department of Medicine, Duke University School of Medicine, Durham, North Carolina.
authors.forename: Sana M
authors.initials: SM
authors.lastname: Al-Khatib
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage; D001281:Atrial Fibrillation / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D015984:Causality; D011307:Drug Prescriptions / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care; D010045:Outpatients / Q000706:statistics & numerical data; D010351:Patient Discharge / Q000706:statistics & numerical data*; D012042:Registries; D020521:Stroke / Q000209:etiology / Q000517:prevention & control*; D014481:United States / Q000453:epidemiology; D014859:Warfarin / Q000008:administration & dosage*; D016903:Drug Monitoring
chemical_list: D000925:Anticoagulants; D014859:Warfarin
keywords: Atrial fibrillation; heart failure; medication adherence; warfarin