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To the Editor: Dr Fonarow and colleagues¹ studied the association between heart failure performance measures and mortality and rehospitalization. While adherence to guidelines is important and could affect hard clinical end points, neither this study nor the American College of Cardiology/American Heart Association (ACC/AHA) clinical performance measures for adults with chronic heart failure² addresses patient medication adherence, an important aspect of this complex issue.

There is evidence that 15% to 30% of patients discontinue guideline-recommended medications within 1 year, and, in some cases, do so as early as 30 days.^3-4 Therefore, assessing quality of care based on performance measures at discharge without also considering patient medication adherence introduces potential for significant bias. Using such measures to judge the quality of efforts at facilities or by physicians who serve population subgroups less likely to adhere to medications is akin to ignoring case mix—an approach that would be judged unfair.^3-5

While we . . . [Full Text of this Article]

Mehdi H. Shishehbor, DO, MPH
shishem@gmail.com
Department of Cardiovascular Medicine
Cleveland Clinic
Cleveland, Ohio

David Litaker, MD, PhD
Department of Epidemiology/Biostatistics
Case Western Reserve University
Cleveland, Ohio

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