ASSOCIATION OF NONCOMPLIANCE WITH CLINICAL TREATMENT GUIDELINES AND DISEASE BURDEN IN A CALIFORNIA MEDICAID CARDIOVASCULAR DISEASE POPULATION

Purpose: To evaluate the prevalence of noncompliance with clinical treatment guidelines for management of cardiovascular disease and its association with disease-related burden.

Method: California Medicaid administrative data from 2002 through 2004 were used to identify patients ≥18 years of age with a diagnosis or combination of any three diseases: coronary artery disease (CAD), heart failure (HF), and hypertension (HYPT). Patients who did not fill any appropriate cardiovascular medication at year 2004 were identified as noncompliant with clinical treatment guidelines. Disease burden was defined as any emergency or inpatient visit. Logistic regressions were used to identify factors associated with disease burden in 2004.

Result: We identified 127,989 patients, 56% with HYPT, 10% with CAD, 10% with HF, 10% with HF combined with CAD, and 14% with HYPT combined with CAD. Mean age was 64 years; 63% were female. Overall, 40% were noncompliant with treatment guidelines. Only 33% of patients who had filled at least one prescription were persistent with their medication. Forty-six percent of patients with HYPT or 50% with CAD did not fill any cardiovascular medication in 2004. Patients with comorbid conditions [HF & CAD (72%), or HYPT & CAD (57%)] were more likely to fill multiple cardiovascular medications than those with one condition [CAD (34%), HF (47%), and HYPT (32%), p<0.0001]. When compared with patients who complied with treatment guidelines, noncompliers were more likely to have any condition-related emergency department or inpatient visit (OR=1.26, 95% CI=1.19-1.34) or cardiovascular disease-related burden (OR=1.44, CI=1.29-1.60). Other factors significantly associated with cardiovascular disease-related burden included type of cardiovascular disease (HF & CAD: OR=10.0, HYPT & CAD: OR=3.1, and HF: OR=5.9 compared to HYPT), comorbidity (OR=1.33, CI=1.31-1.35), number of cardiovascular medications (OR=1.44, CI=1.41-1.47), nonpersistence with medication (OR=1.48, CI=1.38-1.59), Medicaid-only coverage (OR=1.36, CI=1.27-1.45), male gender (OR=1.20, CI=1.13-1.27), and Black race (OR=1.27, CI=1.16-1.40).

Conclusion: Noncompliance with clinical treatment guidelines and nonpersistence with cardiovascular medications were significantly associated with cardiovascular disease-related or any condition-related burden. These associations reinforce the importance of medication initiation and persistence as a strategy to avoid potential cardiovascular or cerebrovascular events.