Introduction: Heart failure is associated with substantial resource utilization and clinical morbidity. Dual health system usage may affect outcomes.
Objective: To evaluate the facility-level association between medication dual use with heart failure treatment and outcomes.
Methods: We determined the association between quartiles of Medicare Part D use (dual use) with quality metrics for heart failure (HF) among eligible veterans at 112 VA facilities using data from 2009-2013 at the facility level. Quality metrics included use of beta-blockers, angiotensin converting enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB), mineralocorticoid receptor antagonists (MRA), and hydralazine and nitrates (in self-identified black veterans) in patients hospitalized with left ventricular ejection fraction ≤ 40% without documented intolerances or contraindications. We also evaluated the association with mortality and readmission rates (all-cause and heart failure-specific) for patients hospitalized with HF. Results were weighted by the number of patients per facility.
Results: There were a mean of 505 patients per facility with a mean age of 73 years. Dual use ranged from 15-52% with an average of 27% +/- 7% (SD). When facilities were grouped into quartiles, facilities with more dual use had higher rates of beta-blocker and, in blacks, hydralazine and nitrate prescriptions (Table 1). There was no significant association between dual use and MRA or ACEi/ARB use. An inverse correlation between dual use and mortality was significant at 1 year post discharge. Readmissions at 30 days (HF or any cause) were not associated with dual use. Dual use remained associated with facility beta-blocker use after adjustment for patient characteristics.
Conclusion: Patients hospitalized with heart failure at facilities with more dual use of Medicare and VA medications were more likely to be treated according to guideline recommendations and had lower mortality at one year.