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Abstract
IntroductionSmall-scale studies have described concerning rates of non-compliance/nonadherence towards groups of medications for primary and secondary prevention. Trends in cardiovascular and cerebrovascular events (CCE) among hospitalized patients with a non-compliant behavior towards medication, on the whole, remains unexplored on a large scale.MethodsUsing the National Inpatient Sample databases (2007-2014), we sought to assess the prevalence and trends in all-cause mortality and CCE in adult patients hospitalized with medication non-compliance. We compared baseline characteristics and comorbidities in the non-compliant patients with and without concomitant in-hospital CCE.ResultsWe identified 7,453,831 adult hospitalizations with medication non-compliance from 2007 to 2014, of which 867,997 (11.6%) patients demonstrated in-hospital CCE. Non-compliant patients with CCE consisted of a higher number of older, white, male patients having greater comorbid risk factors. Non-compliant patients with CCE had higher all-cause in-hospital mortality (3% vs. 0.7%), frequent transfers [4.4% vs. 1.8% transfers to short-term hospitals, and 17.6% vs. 11.6% other transfers (skilled nursing or intermediate care facilities)], lower routine discharges (59.4% vs. 71.1%), and higher mean hospital charges ($52,740 vs. $30,748) compared to non-compliant patients without CCE. Remarkably, this study demonstrates the rising trend in medication non-compliance across all age, sex, and race groups, and related in-hospital mortality, CCE, transfers to other facilities, and the health care cost from 2007 to 2014.ConclusionsWe observed rising trends in the prevalence of medication non-compliance and subsequent in-hospital mortality in hospitalizations among adults from 2007 to 2014. Non-compliant patients with inpatient CCE demonstrated rising trends in all-cause mortality, complications, health care utilization, and cost from 2007 to 2014.
Highlights
Small-scale studies have described concerning rates of non-compliance/nonadherence towards groups of medications for primary and secondary prevention
According to the World Health Organization, medication non-compliance or nonadherence has emerged as a major problem in developing countries where only 50% adherence has been found among patients with a long-term illness and the problem is expected to be greater in underdeveloped countries in view of the prevailing dearth of health care resources and disparities in health care delivery [1]
A meta-analysis of 376,162 patients established the positive effect of guideline-directed medical therapy (GDMT) for both the
Summary
Using the National Inpatient Sample databases (2007-2014), we sought to assess the prevalence and trends in all-cause mortality and CCE in adult patients hospitalized with medication non-compliance. We compared baseline characteristics and comorbidities in the non-compliant patients with and without concomitant in-hospital CCE This retrospective study analyzed the NIS databases (2007-2014), which is a division of the Healthcare Cost and Utilization Project, developed by the Agency for Healthcare Research and Quality. From January 2007 to December 2014, adult patients were identified with a non-compliant behavior towards medications using the International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code V15.81 [10]. These patients were divided into two study groups: those who experienced CCE vs those who did not. We examined and compared the following baseline variables between the two groups: demographics, the source of payer and median household income quartile for patients’ zip code, hospital-related variables, and pre-existing comorbidities
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