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Research Letter
Mar 25, 2013

Variation in Medication Adherence in Heart Failure

Author Affiliations

Author Affiliations: Department of Health Policy and Management, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania (Dr Zhang and Mr Wu); Department of Internal Medicine, School of Medicine, and the Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor (Dr Fendrick); and Department of Health Policy & Management, Harvard School of Public Health, Boston, Massachusetts (Dr Baicker).

JAMA Intern Med. 2013;173(6):468-470. doi:10.1001/jamainternmed.2013.2509

Although recent studies have demonstrated geographic variation in pharmaceutical use and spending,1-4 regional variation in medication adherence in Medicare has not been explored.5 Medication adherence is a critical quality measure and is especially important for Medicare beneficiaries with heart failure (HF), a common condition in which medications can save lives and reduce downstream costs.6 We used 2007-2009 national Part D data for a 5% random sample of Medicare beneficiaries to study regional variation in HF medication adherence.

Our selection criteria included the following: (1) being 18 years or older; (2) having at least 1 inpatient or 2 (nonlaboratory) outpatient claims between January 1, 2007, and December 31, 2009, with selected International Classification of Diseases, Ninth Revision (ICD-9) codes indicating HF on primary, secondary, or third diagnosis; (3) being on at least 1 drug regimen from 1 of 3 therapeutic classes: β-blockers, angiotensin-converting enzymes inhibitors (ACEs) or angiotensin receptor antagonists (ARBs), and/or diuretics7; and (4) being continuously enrolled in Medicare Parts A, B, and D during the follow-up period. The follow-up period was 1 year after the first prescription drug of interest was filled, censored at the end of the study period (December 31, 2009), or death. The resulting 178 102 beneficiaries were assigned to 306 Dartmouth hospital referral regions (HRRs) based on their zip code of residence.