title: Changes in medication regimen complexity and the risk for 90-day hospital readmission and/or emergency department visits in U.S. Veterans with heart failure.
abstract: Heart failure (HF) hospitalization is associated with multiple medication modifications. These modifications often increase medication regimen complexity and may increase the risk of readmission and/or emergency department (ED) visit.
  
  
  
  To determine the association between changes in medication regimen complexity (MRC) during hospitalization of patients with heart failure and the risk of readmission or ED visit at 90 days. Secondary objectives include examining the association between changes in MRC and time to readmission as well as the relationship between number of medications and MRC.
  
  
  
  This was a retrospective cohort study that included U.S. Veterans hospitalized with heart failure. MRC was quantified using the medication regimen complexity index (MRCI). The change in MRCI was the difference between admission MRCI and discharge MRCI recorded during the index hospitalization. Demographic and clinical data were collected to characterize the study population. Patient data for up to one year after discharge was recorded to identify hospital readmissions and ED visits.
  
  
  
  A total of 174 patients were included in the analysis. Sixty-two patients (36%) were readmitted or had an ED visit at 90 days from the index hospitalization. The mean change (SD) in MRCI during the index hospitalization among the cohort was 4.7 (8.3). After multivariate logistic regression analysis, each unit increase in MRCI score was associated with a 4% lower odds of readmission or ED visit at 90 days but this finding was not statistically significant (OR 0.955; 95% CI 0.911-1.001). In the cox proportional hazard model, the median time to hospital readmission or ED visit was 214 days. Each unit increase in MRCI score was associated with a modest but non-significant increase in probability of survival from readmission or ED visit (HR 0.978; 95% CI 0.955, 1.001).
  
  
  
  Changes in medication regimen complexity that occur during hospitalization may also be associated with optimization of medical therapy and do not necessarily portend worse outcomes in patients with HF.
authors.affiliation: UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, 9500 Gilman Drive, MC 0764, La Jolla, CA 92093, USA; VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA. Electronic address: fyam@ucsd.edu.
authors.forename: Felix K
authors.initials: FK
authors.lastname: Yam
authors.affiliation: San Francisco VA Medical Center, 4150 Clement Street (119), San Francisco, CA 94121, USA.
authors.forename: Tiffany
authors.initials: T
authors.lastname: Lew
authors.affiliation: VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA; UC San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Satish A
authors.initials: SA
authors.lastname: Eraly
authors.affiliation: China Medical University, College of Pharmacy, No. 91 Hsueh-Shih Road, Taichung 40402, Taiwan, ROC.
authors.forename: Hsiang-Wen
authors.initials: HW
authors.lastname: Lin
authors.affiliation: VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA; UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, 9500 Gilman Drive, MC 0714, La Jolla, CA 92093, USA.
authors.forename: Jan D
authors.initials: JD
authors.lastname: Hirsch
authors.affiliation: VA San Diego Healthcare System, 3350 La Jolla Village Dr., San Diego, CA, USA; UC San Diego School of Medicine, 9500 Gilman Drive, La Jolla, CA 92093, USA.
authors.forename: Michelle
authors.initials: M
authors.lastname: Devor
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D010359:Patient Readmission / Q000706:statistics & numerical data*; D004364:Pharmaceutical Preparations / Q000008:administration & dosage; D019338:Polypharmacy; D012189:Retrospective Studies; D012306:Risk; D013534:Survival; D013997:Time Factors; D014481:United States; D014728:Veterans
chemical_list: D004364:Pharmaceutical Preparations
keywords: Heart failure; MRCI; Medication regimen complexity index; Outcomes assessment; Patient readmission; Polypharmacy