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Vauterin D, Van Vaerenbergh F, Vanoverschelde A, Quint JK, Verhamme K, Lahousse L. Methods to assess COPD medications adherence in healthcare databases: a systematic review. Eur Respir Rev 2023; 32:230103. [PMID: 37758274 PMCID: PMC10523153 DOI: 10.1183/16000617.0103-2023] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 07/20/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND The Global Initiative for Chronic Obstructive Lung Disease 2023 report recommends medication adherence assessment in COPD as an action item. Healthcare databases provide opportunities for objective assessments; however, multiple methods exist. We aimed to systematically review the literature to describe existing methods to assess adherence in COPD in healthcare databases and to evaluate the reporting of influencing variables. METHOD We searched MEDLINE, Web of Science and Embase for peer-reviewed articles evaluating adherence to COPD medication in electronic databases, written in English, published up to 11 October 2022 (PROSPERO identifier CRD42022363449). Two reviewers independently conducted screening for inclusion and performed data extraction. Methods to assess initiation (dispensing of medication after prescribing), implementation (extent of use over a specific time period) and/or persistence (time from initiation to discontinuation) were listed descriptively. Each included study was evaluated for reporting variables with an impact on adherence assessment: inpatient stays, drug substitution, dose switching and early refills. RESULTS 160 studies were included, of which four assessed initiation, 135 implementation and 45 persistence. Overall, one method was used to measure initiation, 43 methods for implementation and seven methods for persistence. Most of the included implementation studies reported medication possession ratio, proportion of days covered and/or an alteration of these methods. Only 11% of the included studies mentioned the potential impact of the evaluated variables. CONCLUSION Variations in adherence assessment methods are common. Attention to transparency, reporting of variables with an impact on adherence assessment and rationale for choosing an adherence cut-off or treatment gap is recommended.
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Affiliation(s)
- Delphine Vauterin
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Frauke Van Vaerenbergh
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Anna Vanoverschelde
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Jennifer K Quint
- School of Public Health and National Heart and Lung Institute, Imperial College London, London, UK
| | - Katia Verhamme
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Medical Informatics, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Lies Lahousse
- Department of Bioanalysis, Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
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Hickson RP, Robinson JG, Annis IE, Killeya-Jones LA, Fang G. It's Not Too Late to Improve Statin Adherence: Association Between Changes in Statin Adherence from Before to After Acute Myocardial Infarction and All-Cause Mortality. J Am Heart Assoc 2020; 8:e011378. [PMID: 30929542 PMCID: PMC6509715 DOI: 10.1161/jaha.118.011378] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Many older patients have a change in statin adherence-either an increase or a decrease-from before to after an acute myocardial infarction ( AMI ), but its association with mortality is unknown. Methods and Results Using Medicare administrative claims, a cohort of patients ≥66 years old with an AMI hospitalization from 2008 to 2010 was assembled. Statin adherence was measured for 180 days pre- AMI and 180 days post- AMI and categorized as severely nonadherent, moderately nonadherent, or adherent. Categorical change in statin adherence from pre- to post- AMI was assessed. Patients were then followed for up to 18 months for all-cause mortality. A Cox proportional hazards model was applied to estimate the effects of statin adherence change on all-cause mortality, adjusted for patient baseline characteristics. Of 101 011 eligible patients, 20% had a categorical increase in adherence, 16% decreased, and 14% remained nonadherent both pre- and post- AMI . Compared with patients who were always severely nonadherent (both pre- and post- AMI ), patients whose adherence increased from severely nonadherent to adherent (hazard ratio=0.83; 95% CI : 0.75-0.92) and patients who were always adherent (hazard ratio=0.88; 95% CI : 0.82-0.94) were less likely to die; patients whose adherence decreased from moderately nonadherent to severely nonadherent were more likely to die (hazard ratio=1.11; 95% CI : 1.01-1.22). Conclusions After an AMI , patients with decreased statin adherence had the worst mortality outcomes. However, patients with increased statin adherence had a similar risk of mortality compared with continuously adherent patients, suggesting that, even after an AMI , it is not too late to improve statin adherence.
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Affiliation(s)
- Ryan P Hickson
- 1 Division of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NC.,2 Department of Epidemiology UNC Gillings School of Global Public Health University of North Carolina at Chapel Hill Chapel Hill NC
| | - Jennifer G Robinson
- 3 Department of Epidemiology College of Public Health University of Iowa Iowa City IA.,4 Department of Internal Medicine Carver College of Medicine University of Iowa Iowa City IA
| | - Izabela E Annis
- 1 Division of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NC
| | - Ley A Killeya-Jones
- 1 Division of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NC
| | - Gang Fang
- 1 Division of Pharmaceutical Outcomes and Policy UNC Eshelman School of Pharmacy University of North Carolina at Chapel Hill Chapel Hill NC
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3
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Hu F, Warren J, Exeter DJ. Interrupted time series analysis on first cardiovascular disease hospitalization for adherence to lipid-lowering therapy. Pharmacoepidemiol Drug Saf 2019; 29:150-160. [PMID: 31788906 DOI: 10.1002/pds.4916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/04/2019] [Accepted: 10/11/2019] [Indexed: 11/08/2022]
Abstract
PURPOSE We analysed lipid-lowering medication adherence before and after the first hospitalization for cardiovascular disease (CVD) to explore the influence hospitalization has on patient medication adherence. METHODS We extracted a sub-cohort for analysis from 313,207 patients who had primary CVD risk assessment. Adherence was assessed as proportion of days covered (PDC) ≥ 80% based on community dispensing records. Adherence in the 4 quarters (360 days) before the first CVD hospitalization and 8 quarters (720 days) after hospital discharge was assessed for each individual in the sub-cohort. An interrupted time series design using generalized estimating equations was applied to compare the differences of population-level medication adherence rates before and after the first CVD hospitalization. RESULTS Overall, a significant improvement in medication adherence rate from before to after the hospitalization was observed (odds ratio (OR) 2.49 [1.74-3.57]) among the 946 patients included in the analysis. Patients having diabetes history had a higher OR of adherence before the hospitalization than patients without diabetes (1.50 [1.03-2.22]) but no significant difference after the hospitalization (OR 1.13 [0.89-1.43]). Before the first hospitalization, we observed that quarterly medication adherence rate was steady at around 55% (OR 0.97 [0.93-1.01), whereas the trend in adherence over the post-hospitalization period decreased significantly per quarter (OR 0.97 [0.94-0.99]). CONCLUSIONS Patients were more likely to adhere to lipid-lowering therapy after experiencing a first CVD hospitalization. The change in medication adherence rate is consistent with patients having heightened perception of disease severity following the hospitalization.
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Affiliation(s)
- Feiyu Hu
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Jim Warren
- School of Computer Science, University of Auckland, Auckland, New Zealand
| | - Daniel J Exeter
- School of Population Health, University of Auckland, Auckland, New Zealand
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4
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Revue générale sur l’adhésion aux traitements inhalés de la BPCO. Rev Mal Respir 2019; 36:801-849. [DOI: 10.1016/j.rmr.2019.06.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 05/23/2019] [Indexed: 01/12/2023]
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Kang JE, Yu JM, Choi JH, Chung IM, Pyun WB, Kim SA, Lee EK, Han NY, Yoon JH, Oh JM, Rhie SJ. Development and clinical application of an evidence-based pharmaceutical care service algorithm in acute coronary syndrome. J Clin Pharm Ther 2018; 43:366-376. [PMID: 29468708 DOI: 10.1111/jcpt.12665] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Drug therapies are critical for preventing secondary complications in acute coronary syndrome (ACS). The purpose of this study was to develop and apply a pharmaceutical care service (PCS) algorithm for ACS and confirm that it is applicable through a prospective clinical trial. METHODS The ACS-PCS algorithm was developed according to extant evidence-based treatment and pharmaceutical care guidelines. Quality assurance was conducted through two methods: literature comparison and expert panel evaluation. The literature comparison was used to compare the content of the algorithm with the referenced guidelines. Expert evaluations were conducted by nine experts for 75 questionnaire items. A trial was conducted to confirm its effectiveness. Seventy-nine patients were assigned to either the pharmacist-included multidisciplinary team care (MTC) group or the usual care (UC) group. The endpoints of the trial were the prescription rate of two important drugs, readmission, emergency room (ER) visit and mortality. RESULTS AND DISCUSSION The main frame of the algorithm was structured with three tasks: medication reconciliation, medication optimization and transition of care. The contents and context of the algorithm were compliant with class I recommendations and the main service items from the evidence-based guidelines. Opinions from the expert panel were mostly positive. There were significant differences in beta-blocker prescription rates in the overall period (P = .013) and ER visits (four cases, 9.76%, P = .016) in the MTC group compared to the UC group, respectively. WHAT IS NEW AND CONCLUSION We developed a PCS algorithm for ACS based on the contents of evidence-based drug therapy and the core concept of pharmacist services.
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Affiliation(s)
- J E Kang
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, National Medical Center, Seoul, Korea
| | - J M Yu
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - J H Choi
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Konkuk University Medical Center, Seoul, Korea
| | - I-M Chung
- Division of Cardiology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - W B Pyun
- Division of Cardiology, School of Medicine, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - S A Kim
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - E K Lee
- Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea
| | - N Y Han
- College of Pharmacy and Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea
| | - J-H Yoon
- College of Pharmacy, Pusan National University, Busan, Korea
| | - J M Oh
- College of Pharmacy and Research Institute of Pharmaceutical Science, Seoul National University, Seoul, Korea
| | - S J Rhie
- Division of Life and Pharmaceutical Sciences Graduate School, Ewha Womans University, Seoul, Korea.,Department of Pharmacy, Ewha Womans University Mokdong Hospital, Seoul, Korea.,College of Pharmacy, Ewha Womans University, Seoul, Korea
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Hickson RP, Robinson JG, Annis IE, Killeya-Jones LA, Korhonen MJ, Cole AL, Fang G. Changes in Statin Adherence Following an Acute Myocardial Infarction Among Older Adults: Patient Predictors and the Association With Follow-Up With Primary Care Providers and/or Cardiologists. J Am Heart Assoc 2017; 6:e007106. [PMID: 29051213 PMCID: PMC5721894 DOI: 10.1161/jaha.117.007106] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Accepted: 09/15/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hospitalizations for acute myocardial infarctions (AMIs) are associated with changes in statin adherence. It is unclear to what extent adherence changes, which patients are likely to change, and how post-discharge follow-up is associated with statin adherence change. METHODS AND RESULTS This retrospective study used Medicare data for all fee-for-service beneficiaries 66 years and older with an AMI hospitalization in 2008-2010 and statin use before their index AMI. Multivariable multinomial logistic regression models (odds ratio [OR] and 99% confidence interval [CI]) were applied to assess associations between both patient characteristics and follow-up with a primary care provider and/or cardiologist with the outcome of statin adherence change (increase or decrease) from the 6-month pre- to 6-month post-AMI periods. Of 113 296 patients, 64.0% had no change in adherence, while 19.7% had increased and 16.3% had decreased adherence after AMI hospitalization. Black and Hispanic patients were more likely to have either increased or decreased adherence than white patients. Patients who required coronary artery bypass graft surgery (OR, 1.34; 99% CI, 1.21-1.49) or percutaneous transluminal coronary angioplasty/stent procedure (OR, 1.25; 99% CI, 1.17-1.32) during their index hospitalization were more likely to have increased adherence. Follow-up with a primary care provider was only mildly associated with increased adherence (OR, 1.08; 99% CI, 1.00-1.16), while follow-up with a cardiologist (OR, 1.15; 99% CI, 1.05-1.25) or both provider types (OR, 1.21; 99% CI, 1.12-1.30) had stronger associations with increased adherence. CONCLUSIONS Post-AMI changes in statin adherence varied by patient characteristics, and improved adherence was associated with post-discharge follow-up care, particularly with a cardiologist or both a primary care provider and a cardiologist.
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Affiliation(s)
- Ryan P Hickson
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| | - Jennifer G Robinson
- Department of Epidemiology, College of Public Health, The University of Iowa, Iowa City, IA
- Department of Internal Medicine, Carver College of Medicine, The University of Iowa, Iowa City, IA
| | - Izabela E Annis
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| | - Ley A Killeya-Jones
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| | - Maarit Jaana Korhonen
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Ashley L Cole
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
| | - Gang Fang
- Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, The University of North Carolina at Chapel Hill, NC
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Krueger K, Griese-Mammen N, Schubert I, Kieble M, Botermann L, Laufs U, Kloft C, Schulz M. In search of a standard when analyzing medication adherence in patients with heart failure using claims data: a systematic review. Heart Fail Rev 2017; 23:63-71. [DOI: 10.1007/s10741-017-9656-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Jensen ML, Jørgensen ME, Hansen EH, Aagaard L, Carstensen B. Long-term patterns of adherence to medication therapy among patients with type 2 diabetes mellitus in Denmark: The importance of initiation. PLoS One 2017; 12:e0179546. [PMID: 28665996 PMCID: PMC5493299 DOI: 10.1371/journal.pone.0179546] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Accepted: 05/31/2017] [Indexed: 12/01/2022] Open
Abstract
AIMS Poor adherence to medication therapy among type 2 diabetes patients is a clinical challenge. We aimed to determine which factors are associated with the three phases of long-term adherence to medication: initiation, implementation and discontinuation in a register-based study. METHODS Adherence to six medicine groups (metformin, sulfonylureas, acetylsalicylic acid, thiazide diuretics, renin angiotensin system inhibitors, and statins) were analysed among 5,232 patients with type 2 diabetes at a tertiary referral hospital during 1998-2009. Rate-ratios of initiation of treatment, recurrent gaps in supply of medication, and discontinuation of treatment were analysed using Poisson regression. RESULTS Poor initiation rather than poor implementation or discontinuation was the main contributor to medication nonadherence. Polypharmacy was a risk factor for slower initiation of treatment for all six medicine groups (rate ratio ranging 0.79 95%CI [0.72-0.87] to 0.89 95%CI [0.82-0.96] per already prescribed medicine), but once patients were in treatment, polypharmacy was not associated with recurrence of gaps in supply of medication, and polypharmacy was associated with lower risk of discontinuation (rate ratio ranging 0.93 95%CI [0.86-1.00] to 0.96 95%CI [0.93-0.99] per prescribed medicine). Other identified risk factors for slow initiation, poor implementation, and discontinuation were diabetes duration, younger age, and Turkish/Pakistani origin. DISCUSSION This study showed that a risk factor does not necessarily have the same association with all three elements of adherence (initiation, implementation and discontinuation), and that efforts supporting patients introduced to more complex drug combinations should be prioritized.
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Affiliation(s)
- Majken Linnemann Jensen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, Universitetsparken 2, University of Copenhagen, Denmark
| | | | - Ebba Holme Hansen
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, Universitetsparken 2, University of Copenhagen, Denmark
| | - Lise Aagaard
- Faculty of Health, University of Southern Denmark, Odense, Denmark
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Zhao S, Zhao H, Wang X, Gao C, Qin Y, Cai H, Chen B, Cao J. Factors influencing medication knowledge and beliefs on warfarin adherence among patients with atrial fibrillation in China. Patient Prefer Adherence 2017; 11:213-220. [PMID: 28223782 PMCID: PMC5308593 DOI: 10.2147/ppa.s120962] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Warfarin is often used for ischemic stroke prevention in patients with atrial fibrillation (AF), but the factors affecting patient adherence to warfarin therapy have not been fully understood. METHODS A cross-sectional survey was conducted in AF patients undergoing warfarin therapy at least 6 months prior to the study. The clinical data collected using questionnaires by phone interviews included the following: 1) self-reported adherence measured by the Morisky Medication Adherence Scale-8©; 2) beliefs about medicines surveyed by Beliefs about Medicines Questionnaire (BMQ); and 3) drug knowledge as measured by the Warfarin Related Knowledge Test (WRKT). Demographic and clinical factors associated with warfarin adherence were identified using a logistic regression model. RESULTS Two hundred eighty-eight patients completed the survey and 93 (32.3%) of them were classified as nonadherent (Morisky Medication Adherence Scale-8 score <6). Major factors predicting warfarin adherence included age, cardiovascular disorders, WRKT, and BMQ; WRKT and BMQ were independently correlated with adherence to warfarin therapy by multivariate logistic regression analysis. Adherents were more likely to have greater knowledge scores and stronger beliefs in the necessity of their specific medications ([odds ratio {OR} =1.81, 95% confidence interval {CI} =1.51-2.15] and [OR =1.17, 95% CI =1.06-1.29], respectively). Patients with greater concerns about adverse reactions and more negative views of general harm were more likely to be nonadherent ([OR =0.76, 95% CI =0.69-0.84] and [OR =0.82, 95% CI =0.73-0.92], respectively). CONCLUSION BMK and WRKT are related with patient behavior toward warfarin adherence. BMQ can be applied to identify patients at increased risk of nonadherence.
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Affiliation(s)
| | | | - Xianpei Wang
- Department of Cardiovascular Medicine, People’s Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China
| | - Chuanyu Gao
- Department of Cardiovascular Medicine, People’s Hospital of Henan Province, Zhengzhou, Henan, People’s Republic of China
| | - Yuhua Qin
- Department of Pharmacy
- Correspondence: Yuhua Qin, Department of Pharmacy, People’s Hospital of Henan Province, 7 Weiwu Road, Jinshui District, Zhengzhou, Henan 450003, People’s Republic of China, Tel +86 371 6558 0366, Email
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Fleming LM, Kociol RD. Interventions for Heart Failure Readmissions: Successes and Failures. Curr Heart Fail Rep 2014; 11:178-87. [DOI: 10.1007/s11897-014-0192-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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