Abstract 17294: Medication Discrepancies in Heart Failure: an Independent Predictor of Hospitalizations

Abstract

Background: One advantage of the recent mandate by the U.S. government for electronic medical records (EMR) is the ability to reconcile medications in order to limit adverse effects of polypharmacy, thereby potentially improving outcomes. High-risk patients on multiple medications, such as those with heart failure (HF), stand to benefit greatly from the EMR. While medication discrepancies still occur in the EMR, their association with adverse outcomes in HF has not previously been examined. Hypothesis: The number of medication discrepancies in the EMR of HF patients is associated with adverse outcomes. Methods: We prospectively studied 99 HF patients and compared medications lists in the EMR with patient-reported medications to determine the number of medication discrepancies. We dichotomized patients into 2 groups: “Low Discrepancies” (0-1) and “High Discrepancies” (2 or greater). Multivariable linear regression was performed to determine whether increased number of medication discrepancies was independently associated with increased number of hospitalizations over a 1-year period. Results: Patients with increased medication discrepancies (≥ 2) were more symptomatic based on NYHA class, had a higher number of health care providers, and had more hospitalizations over a 1 year period (Table). On multivariable linear regression analysis, the number of medication discrepancies was independently associated with the number of hospitalizations (beta-coefficient 0.17, 95% CI 0.08-0.25), p<0.0001 per each medication discrepancy after adjusting for age, sex, ethnicity, NYHA class, and total number of medications. Conclusion: Despite the use of a well-established EMR in HF patients, medication discrepancies still exist. The number of medications discrepancies is an independent predictor of number of hospitalizations in patients with HF. Improving EMR medication reconciliation, especially in HF patients who have multiple providers, is critical.