Features and Hospital Outcomes for Nonadherent Patients with Heart Failure: Findings from GWTG-HF

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Introduction: Medication and dietary nonadherence are often precipitating factors for heart failure (HF) hospitalization. Recognizing predictors of nonadherence may provide a means to reduce rehospitalization for this vulnerable population. Hypothesis: Nonadherence is a common HF precipitant and is associated with different clinical characteristics and short term outcomes. Methods: Get With The Guidelines (GWTG) HF data were collected from 236 hospitals and 54,322 patients from 01/01/05–12/30/07. Demographics, clinical characteristics, quality of care, and in-hospital outcomes were stratified by precipitating factor for HF admission. Results: Clinicians listed dietary and/or medication nonadherence as the reason for admission in 5576 (10.3%) of all HF hospitalizations. Patients with nonadherence were more likely to be young, male, minority, uninsured, and have nonischemic HF (Table). These patients had a history of more frequent HF hospitalizations, but a shorter length of stay and lower in-hospital mortality (OR 0.71, 95% CI 0.56–0.90) in multivariate regression analysis. Nonadherent patients were equally or more likely to receive guideline-based therapy as adherent patients. Conclusions: Among GWTG-HF participating hospitals, patients with nonadherence as a factor for hospitalization tend to be younger and more sociodemographically disadvantaged, yet have better in-hospital outcomes. Given the high resource utilization in this group, targeted efforts to assess predictors of HF readmission for this vulnerable population have the potential to improve care and lower hospital costs.

	Nonadherence (N=5576, 10.3%)	Other Precipitants (N=24,436 45.0%)	No Known Precipitant (N=24,310 44.7%)	Univariate P-value
Baseline Characteristics
Male (%)	60.4	48.1	48.6	*
Age (yrs)	64.2	73.8	73.4	*
Non-Caucasian (%)	47.0	28.2	22.6	*
Uninsured (%)	11.7	3.5	3.0	*
LVEF (%)	34.9	40.0	39.3	*
Nonischemic HF (%)	57.4	52.3	48.8	*
≥2 HF admits in preceding 6 months (%)	18.2	13.5	8.9	*
In-hospital Outcomes
Mortality (%)	1.55	3.98	3.00	*
Length of Stay (days)	4.99	5.91	5.35	*
GWTG Performance Measures (%)
Appropriate Discharge Instructions	82.6	81.5	81.9	0.2285
Documentation of LVEF	94.5	93.6	94.2	0.0084
ACEI/ARB for LVSD	89.9	84.3	85.7	*
Smoking Cessation Counseling	91.5	88.3	91.6	*
Beta-blocker for LVSD	91.6	89.5	89.0	0.0007

*<0.0001