Adherence to heart failure management medications following cardiac resynchronization therapy

Abstract

Objective: The purpose of this study is to assess the real-world impact of cardiac resynchronization therapy (CRT) on adherence to heart failure (HF) medications.

Methods: MarketScan administrative health care claims data from 2008 to 2014 among patients with HF were used. The date of first CRT implantation served as the index date. Adherence to guideline-directed medical therapy (GDMT) classes were compared during pre- and post-index periods using proportion of days covered (PDC). Comparisons between the two periods were made using the Wilcoxon sign-rank test for continuous PDC and McNemar's test for dichotomized PDC.

Results: Increases in medication adherence were observed for major classes of HF GDMT medications. Specifically, adherence to angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARB), beta blockers (BB), and furosemide increased by 22, 24, 32, and 28% (all p < .001), respectively, in the 12 months pre to 12 months post-CRT. Large increases between the pre- and post-CRT period were also observed when considering adherence as dichotomized PDC ≥0.80 in the 12 months pre- versus post-CRT.

Conclusion: Adherence to HF medications significantly improved among HF patients post-CRT implantation. Further research is needed to better understand the underlying determinants of this effect, including whether the effect is attributable to factors such as enhanced patient monitoring and improved access to high-quality specialized HF care among patients receiving CRT.

Keywords:

• Cardiac resynchronization therapy
• heart failure
• adherence

Transparency

Declaration of funding

This study was supported by Medtronic, Mounds View, MN

Declaration of financial/other relationships

MD, ED, PL, and MSD are employees of Analysis Group Inc., which receives grant/research support from Medtronic Inc.; YX and DK were employees of Analysis Group Inc. when this research was conducted; ST, DM, and XL are employees of Medtronic Inc. and report receiving a salary and stock options; JD and BS received consulting fees from Medtronic Inc. for their participation in this study. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work but have no other relevant financial relationships to disclose.

Author contributions

All authors were involved in the conception and design, or analysis and interpretation of the data; the drafting of the paper or revising it critically for intellectual content; and the final approval of the version to be published. All authors agree to be accountable for all aspects of the work.

Previous presentations

Part of the material in this manuscript was presented at the Academy of Managed Care Pharmacy (AMCP) Nexus 2016, held in National Harbor, Maryland, October 3–6, 2016; 20th Heart Failure Society of America (HFSA) annual scientific meeting, held in Kissimmee, Florida, September 17–20, 2016; and the Heart Rhythm Society’s (HRS) 39th Annual Scientific Session held in Boston, MA May 9–12, 2018.

Acknowledgements

No assistance in the preparation of this manuscript is to be declared.