Ability of medication adherence, knowledge and skills to predict emergency department visits in older adults with heart failure

Abstract

Purpose Chronic heart failure (HF) affects 5 million Americans most of whom are over 65 years of age. The resultant cost approaches $18 billion annually largely due to exacerbations that may result in emergency department visits. Drugs, which are the primary treatment for HF, have limited effectiveness when patients are non-adherent. Our purpose is to determine whether medication adherence, knowledge, and skills predict the number of emergency department visits in older adult patients with HF. Methods In a six-month prospective, observational study at an urban, university-affiliated hospital we assessed medication knowledge and skills of 61 older HF patients. Medication adherence to cardiovascular drugs was calculated from electronic dosing monitors and pharmacy refill records. Results Patients were 65%+ 9 years of age (72% women, 51% white) with 11 ± 2 years of formal education, New York Heart Association functional class I: 35%; II: 47%; III: 18%, and were taking 10.2 ± 3.1 oral prescription medications. Mulitvariate log-linear model adjusted for demographic variables showed that insufficient ability to read standard prescription and auxiliary labels (P = 0.002) and reduced medication adherence (P <0.001) were associated with increased number of ED visits. Conclusion Adherence to cardiovascular medications and ability to read a prescription label predicted emergency department visits and represent potential targets for educational intervention. Clinical Pharmacology & Therapeutics (2004) 75, P76–P76; doi: 10.1016/j.clpt.2003.11.286