title: A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure.
abstract: OBJECTIVE
  To determine whether a single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure.
  
  
  BACKGROUND
  Poor medication adherence is associated with increased morbidity and mortality. Having a simple means of identifying suboptimal medication adherence could help identify at-risk patients for interventions.
  
  
  METHODS
  We performed a prospective cohort study in 592 participants with heart failure within a four-site randomised trial.
  
  
  METHODS
  Self-report medication adherence was assessed at baseline using a single-item question: 'Over the past seven days, how many times did you miss a dose of any of your heart medication?' Participants who reported no missing doses were defined as fully adherent, and those missing more than one dose were considered less than fully adherent. The primary outcome was combined all-cause hospitalisation or death over one year and the secondary endpoint was heart failure hospitalisation. Outcomes were assessed with blinded chart reviews, and heart failure outcomes were determined by a blinded adjudication committee. We used negative binomial regression to examine the relationship between medication adherence and outcomes.
  
  
  RESULTS
  Fifty-two percent of participants were 52% male, mean age was 61 years, and 31% were of New York Heart Association class III/IV at enrolment; 72% of participants reported full adherence to their heart medicine at baseline. Participants with full medication adherence had a lower rate of all-cause hospitalisation and death (0·71 events/year) compared with those with any nonadherence (0·86 events/year): adjusted-for-site incidence rate ratio was 0·83, fully adjusted incidence rate ratio 0·68. Incidence rate ratios were similar for heart failure hospitalisations.
  
  
  CONCLUSIONS
  A single medication adherence question at baseline predicts hospitalisation and death over one year in heart failure patients.
  
  
  CONCLUSIONS
  Medication adherence is associated with all-cause and heart failure-related hospitalisation and death in heart failure. It is important for clinicians to assess patients' medication adherence on a regular basis at their clinical follow-ups.
authors.affiliation: The School of Nursing, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Jia-Rong
authors.initials: JR
authors.lastname: Wu
authors.forename: Darren A
authors.initials: DA
authors.lastname: DeWalt
authors.forename: David W
authors.initials: DW
authors.lastname: Baker
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Bernice
authors.initials: B
authors.lastname: Ruo
authors.forename: Kristen
authors.initials: K
authors.lastname: Bibbins-Domingo
authors.forename: Aurelia
authors.initials: A
authors.lastname: Macabasco-O'Connell
authors.forename: George M
authors.initials: GM
authors.lastname: Holmes
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Broucksou
authors.forename: Brian
authors.initials: B
authors.lastname: Erman
authors.forename: Victoria
authors.initials: V
authors.lastname: Hawk
authors.forename: Crystal W
authors.initials: CW
authors.lastname: Cene
authors.forename: Christine DeLong
authors.initials: CD
authors.lastname: Jones
authors.forename: Michael
authors.initials: M
authors.lastname: Pignone
mesh_terms: D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012651:Self Medication; D057566:Self Report; D011795:Surveys and Questionnaires
keywords: heart failure; medication adherence; outcomes; self-report