Table 1

Association of measure non-adherence with subsequent all-cause mortality

Measure non-adherence on any admission
Measure90-day adjusted* HR (95% CI)365-day adjusted* HR (95% CI)
Acute myocardial infarction
 Aspirin at arrival6.90 (0.85 to 56.13)6.71 (1.54 to 29.30)
 β blocker at arrival3.82 (0.76 to 19.08)4.25 (1.28 to 14.07)
 PCI <90 minNANA
 Aspirin (D/C)6.23 (0.83 to 46.78)2.51 (0.35 to 18.27)
 Beta blocker (D/C)NA1.65 (0.23 to 11.96)
 ACEI/ARB1.58 (0.58 to 4.27)1.24 (0.62 to 2.51)
 Smoking counselling2.51 (0.71 to 8.93)1.56 (0.54 to 4.52)
Arrival group measure3.46 (1.31 to 9.15)2.71 (1.28 to 5.74)
Discharge group measure2.85 (1.47 to 5.56)2.18 (1.32 to 3.59)
Failure on any measure, any admission2.67 (1.51 to 4.73)2.08 (1.36 to 3.19)
Heart failure
 ACEI/ARB for LVSD1.98 (1.10 to 3.55)1.54 (1.03 to 2.29)
 LV assessment1.88 (0.83 to 4.28)1.74 (0.92 to 3.29)
 Discharge instruction1.22 (0.84 to 1.78)1.23 (0.97 to 1.55)
 Smoking counselling2.22 (0.83 to 5.95)2.28 (1.24 to 4.21)
Patient information measures1.19 (0.82 to 1.72)1.25 (0.99 to 1.57)
Failure on any measure, any admission0.97 (0.74 to 1.28)1.03 (0.85 to 1.24)
Pneumonia
 Antibiotic <4 h1.13 (0.68 to 1.85)1.05 (0.74 to 1.49)
 Blood culture timing1.86 (1.07 to 3.21)1.59 (1.10 to 2.30)
 O2 assessmentNANA
 Antibiotic selection1.42 (0.55 to 3.70)1.28 (0.69 to 2.36)
 Influenza vaccine assessment0.97 (0.57 to 1.68)1.04 (0.71 to 1.52)
 Pneumonia vaccine assessment1.06 (0.71 to 1.59)1.18 (0.90 to 1.56)
 Smoking counselling1.19 (0.53 to 2.68)1.59 (0.93 to 2.70)
Arrival group measures1.46 (0.98 to 2.18)1.20 (0.91 to 1.57)
Health maintenance measures1.07 (0.73 to 1.56)1.10 (0.86 to 1.44)
Failure on any measure, any admission1.23 (0.87 to 1.75)1.24 (0.98 to 1.58)
Time-weighted measure non-adherence
Measure90-day adjusted* HR (95% CI)365-day adjusted* HR (95% CI)
Acute myocardial infarction
 Aspirin at arrival1.05 (0.69 to 1.59)1.16 (0.96 to 1.39)
 Beta blocker at arrival1.16 (0.98 to 1.37)1.20 (1.06 to 1.36)
 PCI <90 minNANA
 Aspirin (D/C)1.20 (0.98 to 1.47)1.10 (0.90 to 1.34)
 Beta blocker (D/C)NA1.05 (0.86 to 1.28)
 ACEI/ARB1.05 (0.95 to 1.16)1.02 (0.95 to 1.09)
 Smoking counselling1.10 (0.97 to 1.25)1.05 (0.94 to 1.17)
Arrival group measures1.14 (0.98 to 1.33)1.15 (1.03 to 1.27)
Discharge group measures1.22 (1.09 to 1.38)1.18 (1.08 to 1.29)
Average non-adherence score1.16 (1.04 to 1.29)1.17 (1.08 to 1.26)
0–49% adherence (vs all)3.06 (1.30 to 7.16)3.06 (1.72 to 5.43)
50–99% adherence (vs all)2.45 (1.19 to 5.06)1.53 (0.84 to 2.78)
Heart failure
 ACEI/ARB for LVSD1.06 (0.99 to 1.13)1.04 (0.99 to 1.08)
 LV assessment1.03 (0.93 to 1.14)1.03 (0.95 to 1.11)
 Discharge instruction1.01 (0.97 to 1.05)1.01 (0.99 to 1.04)
 Smoking counselling1.07 (0.96 to 1.19)1.06 (0.99 to 1.14)
Patient information measures0.99 (0.95 to 1.03)1.01 (0.98 to 1.03)
Average non-adherence score0.97 (0.91 to 1.03)0.99 (0.95 to 1.03)
0–49% adherence (vs all)0.68 (0.46 to 1.01)0.80 (0.62 to 1.03)
50–99% adherence (vs all)1.31 (0.94 to 1.81)1.30 (1.03 to 1.63)
Pneumonia
 Antibiotic <4 h1.01 (0.96 to 1.06)1.00 (0.97 to 1.04)
 Blood culture timing1.06 (1.00 to 1.12)1.04 (1.00 to 1.08)
 O2 assessmentNANA
 Antibiotic selection1.04 (0.95 to 1.15)1.03 (0.97 to 1.10)
 Influenza vaccine assessment1.00 (0.94 to 1.05)1.00 (0.97 to 1.04)
 Pneumonia vaccine assessment1.00 (0.96 to 1.04)1.02 (0.99 to 1.05)
 Smoking counselling1.03 (0.95 to 1.12)1.05 (0.99 to 1.11)
Arrival group measures1.04 (0.94 to 1.15)1.02 (0.95 to 1.09)
Health maintenance measures1.00 (0.96 to 1.04)1.01 (0.98 to 1.04)
Average non-adherence score1.03 (0.97 to 1.11)1.05 (1.006 to 1.10)
0–49% adherence (vs all)1.44 (0.90 to 2.31)1.54 (1.11 to 2.14)
50–99% adherence (vs all)1.15 (0.78 to 1.69)1.14 (0.87 to 1.48)
  • * Confounders included patient's age, gender, race, socioeconomic status, comorbidities at admission, DNR order on admission for arrival measures, DNR order anytime during hospitalisation for other measures, and transfer to Massachusetts General Hospital for non-arrival measures.

  • Per 10% decrease in adherence score.

  • ACEI/ARB, angiotensin-converting enzyme inhibitor/angiotensin receptor blockade; D/C, discharge; DNR, do not resuscitate; LV, left ventricle; LVSD, left ventricular systolic dysfunction; NA, not available; PCI, percutaneous coronary intervention.