Original Article

A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure

Corresponding Author

Jia-Rong Wu PhD, RN

Assistant Professor

The School of Nursing, University of North Carolina, Chapel Hill, NC, USA

Correspondence: Jia-Rong Wu, Assistant Professor, School of Nursing, University of North Carolina, 435 Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460, USA. Telephone: +919 966 8057.

E-mail:[email protected]

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Darren A DeWalt MD, MPH,

Darren A DeWalt MD, MPH

Associate Professor

Division of General Medicine, The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

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David W Baker MD, MPH,

David W Baker MD, MPH

Professor

Division of General Internal Medicine, Northwestern University, Evanston, IL, USA

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Dean Schillinger MD,

Dean Schillinger MD

Professor

Division of General Internal Medicine Department of Medicine at San Francisco General Hospital, University of California, San Francisco, CA, USA

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Bernice Ruo MD, MAS,

Bernice Ruo MD, MAS

Assistant Professor

Division of General Internal Medicine, Northwestern University, Evanston, IL, USA

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Kristen Bibbins-Domingo MD, PhD,

Kristen Bibbins-Domingo MD, PhD

Professor

Division of General Internal Medicine Department of Medicine at San Francisco General Hospital, University of California, San Francisco, CA, USA

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Aurelia Macabasco-O'Connell PhD, RN,

Aurelia Macabasco-O'Connell PhD, RN

Associate Professor

School of Nursing, University of California, Los Angeles, CA, USA

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George M Holmes PhD,

George M Holmes PhD

Assistant Professor

Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA

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Kimberly A Broucksou MSW, MPA,

Kimberly A Broucksou MSW, MPA

Project Manager

The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

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Brian Erman MSPharm,

Brian Erman MSPharm

Analyst

The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

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Victoria Hawk MPH,

Victoria Hawk MPH

Health Educator

The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

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Crystal W Cene MD, MPH,

Crystal W Cene MD, MPH

Assistant Professor

Division of General Medicine, University of North Carolina, Chapel Hill, NC, USA

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Christine DeLong Jones MD, MS,

Christine DeLong Jones MD, MS

University of Colorado School of Medicine, Aurora, CO, USA

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Michael Pignone MD, MPH,

Michael Pignone MD, MPH

Professor

Division of General Medicine, University of North Carolina, Chapel Hill, NC, USA

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Jia-Rong Wu PhD, RN,

Corresponding Author

Jia-Rong Wu PhD, RN

Assistant Professor

The School of Nursing, University of North Carolina, Chapel Hill, NC, USA

Correspondence: Jia-Rong Wu, Assistant Professor, School of Nursing, University of North Carolina, 435 Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460, USA. Telephone: +919 966 8057.

E-mail:[email protected]

Search for more papers by this author

Darren A DeWalt MD, MPH,

Darren A DeWalt MD, MPH

Associate Professor

Division of General Medicine, The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

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David W Baker MD, MPH,

David W Baker MD, MPH

Professor

Division of General Internal Medicine, Northwestern University, Evanston, IL, USA

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Dean Schillinger MD,

Dean Schillinger MD

Professor

Division of General Internal Medicine Department of Medicine at San Francisco General Hospital, University of California, San Francisco, CA, USA

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Bernice Ruo MD, MAS,

Bernice Ruo MD, MAS

Assistant Professor

Division of General Internal Medicine, Northwestern University, Evanston, IL, USA

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Kristen Bibbins-Domingo MD, PhD,

Kristen Bibbins-Domingo MD, PhD

Professor

Division of General Internal Medicine Department of Medicine at San Francisco General Hospital, University of California, San Francisco, CA, USA

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Aurelia Macabasco-O'Connell PhD, RN,

Aurelia Macabasco-O'Connell PhD, RN

Associate Professor

School of Nursing, University of California, Los Angeles, CA, USA

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George M Holmes PhD,

George M Holmes PhD

Assistant Professor

Department of Health Policy and Management, University of North Carolina, Chapel Hill, NC, USA

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Kimberly A Broucksou MSW, MPA,

Kimberly A Broucksou MSW, MPA

Project Manager

The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

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Brian Erman MSPharm,

Brian Erman MSPharm

Analyst

The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

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Victoria Hawk MPH,

Victoria Hawk MPH

Health Educator

The Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, USA

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Crystal W Cene MD, MPH,

Crystal W Cene MD, MPH

Assistant Professor

Division of General Medicine, University of North Carolina, Chapel Hill, NC, USA

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Christine DeLong Jones MD, MS,

Christine DeLong Jones MD, MS

University of Colorado School of Medicine, Aurora, CO, USA

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Michael Pignone MD, MPH,

Michael Pignone MD, MPH

Professor

Division of General Medicine, University of North Carolina, Chapel Hill, NC, USA

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First published: 20 December 2013

https://doi.org/10.1111/jocn.12471

Citations: 31

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Abstract

Aims and objectives

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.

Design

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.

Conclusion

A single medication adherence question at baseline predicts hospitalisation and death over one year in heart failure patients.

Relevance to clinical practice

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.

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Volume23, Issue17-18

September 2014

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A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure

Abstract

Aims and objectives

Background

Design

Methods

Results

Conclusion

Relevance to clinical practice

References

Citing Literature

References

Information

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A single-item self-report medication adherence question predicts hospitalisation and death in patients with heart failure

Abstract

Aims and objectives

Background

Design

Methods

Results

Conclusion

Relevance to clinical practice

References

Citing Literature

References

Related

Information