Medication adherence and survival among hospitalized heart failure patients in a tertiary hospital in Tanzania: a prospective cohort study

Medication adherence and persistence in heart failure: A protocol for a systematic review and meta-analysis

OBJECTIVE

To study medication adherence and persistence among heart failure patients, assess the methods utilised for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes.

METHODS

A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalisation, emergency visits, and mortality. The I2 statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews CRD42024509542.

DISCUSSION

This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.

Medication adherence and persistence in heart failure: A protocol for a systematic review and meta-analysis

OBJECTIVE

To study medication adherence and persistence among heart failure patients, assess the methods utilized for estimating medication adherence, and identify optimal adherence thresholds and their impact on clinical outcomes.

METHODS

A systematic search will be conducted in PubMed, Embase, CINAHL, Web of Science, and Scopus databases. Observational studies assessing medication adherence or persistence among heart failure patients via electronic healthcare databases will be included. A narrative synthesis will describe medication adherence and persistence reported and methods used to measure it. A meta-analysis will be attempted to evaluate the impact of secondary medication adherence (multiple and by drug class) on clinical outcomes, including hospitalization, emergency visits, and mortality. The I statistic will be employed to study heterogeneity and the GRADE framework to evaluate evidence certainty. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines and is registered with the Prospective Register of Ongoing Systematic Reviews (PROSPERO) CRD42024509542.

DISCUSSION

This study aims to evaluate medication adherence and persistence in heart failure management through electronic health databases, intending to explore widely used measurement methods and their limitations, and to identify adherence thresholds associated with improved clinical outcomes. By examining these aspects, we anticipate proposing enhancements for future research and establishing desired adherence goals. This approach highlights the expected significance of our findings in advancing patient care and research methodologies.

The association of illness perception and related factors with treatment adherence among chronic hemodialysis patients with cardio-renal syndrome in Yemen

Background

Patients' illness perceptions are cognitive representations or beliefs structured around their condition. These perceptions have been associated with several important outcomes, including functional recovery and treatment adherence.

Objective

The aim of this study was to investigate the association between illness perception and related factors with treatment adherence among hemodialysis patients with cardio-renal syndrome in Yemen.

Methods

This cross-sectional study was conducted at two dialysis centers in Hadhramout Governorate, Yemen, from February to May 2021. Three self-administered questionnaires were used to collect the data. Data analysis was performed using SPSS version 23.0 with a significance level set at p < 0.05.

Results

In total, 100 patients answered all questions with a total response rate of 100%. The mean age ± standard deviation of participants was 53.46 ± 14.24 years. Most patients (87%) had a low level of treatment adherence, particularly in medication and diet restriction adherence. Furthermore, most patients (90%) had a moderate-to-high level of perceived illness threat. The findings revealed no significant correlation between overall illness perception and overall treatment adherence (r = 0.003, p = 0.975). However, the perceived consequences (r = -0.210, p < 0.05), and perceived timeline subscales (r = -0.276, p < 0.01) showed a negative correlation with total treatment adherence. Additional findings revealed a significant positive link between adherence and cardiac disorders (β = 4.292, p = 0.009), as well as a strong correlation between adherence and income level (β = 11.132, p < 0.001).

Conclusions

Our research found that most patients with cardio-renal syndrome had poor treatment adherence and had a moderate-to-high level of perceived illness threat. The results of the study showed that perceived consequences and perceived timeline subscales of illness perceptions had a negative correlation with overall treatment adherence, and the results revealed a significant positive link between adherence and cardiac disorders, as well as a strong correlation between adherence and income level. The findings suggest that nurses and clinicians should assess the illness perceptions specific to patients with cardio-renal syndrome disease when developing multidisciplinary interventions to help patients cope with and manage different aspects of their condition.

The Correlation Between Medication Self-Management with Rational Medication Use Self-Efficacy and Medication Literacy in Patients with Stroke

Objective

To investigate medication self-management in patients with stroke and its relationship with general demographics, self-efficacy and medication literacy.

Methods

This was a cross-sectional study. Patients with stroke who received treatment in Jiangnan University Affiliated Hospital between July 2023 and January 2024 were selected as the study participants. The General Characteristics Questionnaire, the Self-Efficacy for Appropriate Medication Use Scale (SEAMS), the Chinese version of the Drug Literacy Scale and the Self-Administration of Medication tool were used to investigate patients with stroke and to analyse the factors influencing the self-management of their medication.

Results

A total of 210 patients were included in this study. The average score of medication self-management was 66.71 (standard deviation = 9.55), and SEAMS and medication literacy scores were positively correlated with the total score of medication self-management behaviour. Furthermore, we found that the Barthel index (BI), SEAMS and medication literacy scores were the main predictors of medication self-management behaviour (R 2 = 0.790, p < 0.001).

Conclusion

This study found that patients with stroke with a lower BI and higher SEAMS or medication literacy scores also had higher levels of medication self-management. The factors discussed in this study may help develop individualised interventions in medication self-management for patients with stroke.

Predictors to Poor Quality of Life Among Patients with Heart Failure and Its Correlation with Their Medication Adherence: Finding for Healthcare Improvement and Follow-Up

Background

Understanding medication adherence and its relationship with quality of life (QoL) is essential for improving health outcomes in patients with heart failure (HF).

Objective

This study aimed to investigate the predictors of poor quality of life and its relationship with medication adherence among patients with heart failure.

Methods

A cross-sectional correlational study was performed on 229 patients with HF receiving care at the Cardiac Center of King Salman Specialist Hospital from March to June 2024. Data were collected using a structured questionnaire comprising patient demographics, the Minnesota Living with Heart Failure Questionnaire (MLHFQ) to assess QoL, and the General Medication Adherence Scale (GMAS) to measure medication adherence.

Results

The mean medication adherence score among patients with heart HF was 17.53 ± 6.94. The level of adherence was moderate among most patients (47.2%), high (29.7%), and poor (23.1%). Regarding QoL, the mean total score for overall QoL was 42.16 ± 20.53. Specifically, the mean scores were 15.24 ± 8.65 and 10.53 ± 5.82 for the physical and emotional dimensions of QoL, respectively. More than half of the patients experienced poor QoL, while moderate QoL was observed in 31.9% and good QoL in 17% of patients. Furthermore, there were moderate negative correlations between medication adherence and physical QoL (r= -0.51), emotional QoL (r = -0.59), and overall QoL (r = -0.59), all of which were statistically significant (p <0.001).

Conclusion

Moderate-to-poor levels of medication adherence and QoL were found among HF patients receiving care in Hail City. Therefore, interventions to improve medication adherence among patients with HF must be prioritized to enhance health outcomes and QoL. It is also crucial to address the factors that negatively influence medication adherence to overcome the barriers that hinder optimal medication adherence.

Prevalence and risk factors of mortality among heart failure patients in low resource setting hospitals: a multicenter prospective observational study

Background

Heart failure is a significant worldwide health problem that leads to mortality. Therefore, this study aimed to evaluate treatment outcomes and associated factors of heart failure patients who were admitted to hospitals in the southwest of Ethiopia.

Methods and participants

A multicenter prospective observational study was conducted from 1 February to 1 August 2021. Drug therapy problems were assessed as per the Cipolle, Strands, and Morley drug therapy problems classification method. The drug therapy was registered by using the drug-related problem registration format. The results of logistic regression analysis was interpreted as crude odds ratio and adjusted odds ratio (AOR) at 95% confidence interval (CI) to determine the association between dependent and independent variables.

Results

In our study settings, a total of 205 (85.1%) heart failure patients showed improvement and 36 (14.9%) died at hospital discharge. Being ≥65 years (AOR = 7.14, 95% CI: 2.04-.25.01, P = 0.002), a previous hospitalization (AOR = 6.20, 95% CI: 1.81-21.21, P = 0.004), and the presence of medication-related problems (AOR = 3.65, 95% CI: 1.13-11.73, P = 0.03) were the predictors of mortality.

Conclusion

The prevalence of in-hospital mortality among heart failure patients was found to be high. Previous hospitalization, older age, and the presence of drug therapy problems were the predictors of mortality among heart failure patients. Therefore, proper attention should be given to the management of elderly and re-admitted heart failure patients in addition to their regular care. In addition, hospitals should implement clinical pharmacy services to address any drug-related problems.

Control Attitudes Scale-Revised-Brazilian Version

BACKGROUND

Heart failure demands self-care skills and behaviors that can be negatively impacted by a low level of perceived control (PC), a belief about having the necessary resources to deal with negative events. Having valid and reliable instruments to measure PC is important to support interventions that improve self-care and related outcomes. The Control Attitudes Scale-Revised (CAS-R) was developed in the United States to measure PC in cardiac conditions. In Brazil, there are no instruments available to measure this construct.

OBJECTIVE

The aims of this study were to translate and adapt the CAS-R to the Brazilian population and to assess the content validity of the adapted version.

METHODS

The CAS-R was translated, back-translated, and assessed by an expert committee for linguistic equivalences. An agreement > 80% was considered adequate. Content validity (clarity, theoretical relevance, and practical pertinence) was assessed by both an expert professional panel (n = 6-8) and a panel of patients with heart failure (n = 40). A content validity coefficient > 0.70 was considered acceptable.

RESULTS

The translations to Brazilian Portuguese were considered consistent with the original CAS-R. In the third round of linguistic equivalence assessment, all items achieved acceptable agreement, except for 2 items. After modifications to the instrument to achieve adequate equivalences, the adapted version had a final content validity coefficient of 0.93. Most patients were able to understand the instrument.

CONCLUSIONS

The CAS-R-Brazilian version is equivalent to the original CAS-R and has satisfactory evidence of content validity. Additional psychometric testing will be performed to allow for the assessment of PC in individuals with heart failure in Brazil.

Determinants of medication non-adherence among patients with chronic diseases at community pharmacy settings in South Gondar Zone, Northwest Ethiopia: a multicenter cross-sectional study

Background

Medication non-adherence is a significant public health concern in managing patients with chronic diseases, and community pharmacists are on the frontline in the management of chronic medications. Chronic diseases require lifelong pharmacotherapy and understanding the determinants of medication adherence has paramount importance to develop strategies that improve medication adherence and treatment outcomes. Thus, this study aimed to assess the magnitude of medication non-adherence and its contributing factors among patients with chronic diseases attending community pharmacies in South Gondar Zone, Northwest Ethiopia.

Methods

A multicenter cross-sectional study was conducted at community pharmacies in South Gondar Zone from September 01 to October 30, 2023. Medication adherence was assessed using a structured questionnaire using the Adherence in Chronic Diseases Scale (ACDS). Statistical Package for Social Sciences (SPSS) version 25 was used for analysis. Association between the outcome variable and independent variables was performed using binary logistic regression and a p-value of <0.05 was considered statistically significant.

Results

Among three hundred and eighty six (386) study participants recruited in this study, more than half of them 222 (57.51%, 95%CI: 52.4% - 62.5%) were low adherent to their medications. Concerning determinants of medication non-adherence; the presence of side effects (AOR =2.1, 95%CI=1.33-3.29), unable to get ever counseling from community pharmacists (AOR=2.3, 95%CI= 1.46-3.58), and poor about their medications (AOR=3.1, 95% CI= 1.96-4.82) were significantly associated with patients' non-adherence to medications.

Conclusion

The medication adherence level in this study was suboptimal, with a significant proportion of the patients being non-adherent to their medications. The presence of side effects, unable to get ever counseling, and poor knowledge about their medications were statistically significant factors of poorer medication adherence. Hence, healthcare professionals, especially community pharmacists, have a crucial role in designing the schedule for health education concerning the needs of these patients in community pharmacy settings.

The financial burden of noncommunicable diseases from out-of-pocket expenditure in sub-Saharan Africa: a scoping review

The growing financial burden of noncommunicable diseases (NCDs) in sub-Saharan Africa (SSA) hinders the attainment of the sustainable development goals. However, there has been no updated synthesis of evidence in this regard. Therefore, our study summarizes the current evidence in the literature and identifies the gaps. We systematically search relevant databases (PubMed, Scopus, ProQuest) between 2015 and 2023, focusing on empirical studies on NCDs and their financial burden indicators, namely, catastrophic health expenditure (CHE), impoverishment, coping strategies, crowding-out effects and unmet needs for financial reasons (UNFRs) in SSA. We examined the distribution of the indicators, their magnitudes, methodological approaches and the depth of analysis. The 71 included studies mostly came from single-country (n = 64), facility-based (n = 52) research in low-income (n = 22), lower-middle-income (n = 47) and upper-middle-income (n = 10) countries in SSA. Approximately 50% of the countries lacked studies (n = 25), with 46% coming from West Africa. Cancer, cardiovascular disease (CVD) and diabetes were the most commonly studied NCDs, with cancer and CVD causing the most financial burden. The review revealed methodological deficiencies related to lack of depth, equity analysis and robustness. CHE was high (up to 95.2%) in lower-middle-income countries but low in low-income and upper-middle-income countries. UNFR was almost 100% in both low-income and lower-middle-income countries. The use of extreme coping strategies was most common in low-income countries. There are no studies on crowding-out effect and pandemic-related UNFR. This study underscores the importance of expanded research that refines the methodological estimation of the financial burden of NCDs in SSA for equity implications and policy recommendations.

Medication adherence and associated factors among chronic heart failure patients on follow-up in north Shewa public hospitals, Oromia region, Ethiopia

BACKGROUND

Chronic heart failure affects approximately 26 million people globally. World Health Organization data show that only approximately half of chronically ill patients in developed countries adhere to recommended medication, with even lower rates in developing countries. Medication adherence is critical for managing chronic heart failure symptoms, delaying disease progression, and preventing hospitalizations. However, poor adherence increases rehospitalization, morbidity, mortality, and healthcare costs.

OBJECTIVE

To assess medication adherence and associated factors among chronic heart failure patients on follow-up at North Shewa Public Hospitals, Oromia Region, Ethiopia, in 2023.

METHODS

This institutional-based cross-sectional study was conducted from March 1 to April 30, 2023, G.C. A total of 603 individuals were selected consecutively among those who underwent chronic OPD after being proportionally allocated to five hospitals in the zone. The data were collected using an interviewer-administered questionnaire and a medical chart review. The data were entered into Epi-data version 3.1 and then exported to SPSS version 26 for analysis. The multivariable logistic regression model included variables with a P value < 0.25 in the bivariate analysis. The degree of association was expressed using an adjusted odds ratio (AOR) with a 95% confidence interval (CI) at a P value < 0.05.

RESULTS

Among the 603 patients, 56% had optimal medication adherence, with a 95% CI of 52.1 to 60. Being able to read and write (AOR: 2.20; 95% CI: 1.34, 3.61), having a secondary education (AOR: 1.97; 95% CI: 1.06, 3.67), having community-based health insurance (AOR: 1.82; 95% CI: 1.22, 2.71), not having comorbidities (AOR: 1.82; 95% CI: 1.18, 2.52), taking several drugs < 2 (AOR: 2.11; 95% CI: 1.20, 2.45), not adding salt when cooking (AOR: 1.72; 95% CI: 1.20, 2.45), and asking a doctor or nurse without fear (AOR: 1.87; 95% CI: 1.03, 3.40) were factors associated with medication adherence among CHF patients.

CONCLUSION

This study revealed that 56% of chronic heart failure patients had optimal medication adherence. Factors associated with higher adherence included higher education, community health insurance, lack of comorbidities, fewer medications, avoiding added salt, and comfortable communication with providers. Health professionals should provide education to strengthen medication adherence.

Treatment satisfaction and medication adherence and predictors among patients with heart failure in Ethiopia: a hospital-based cross-sectional study

Background

Globally, about 18 million people died from cardiovascular diseases (CVDs) in 2019, over three-quarters in developing countries. Non-adherence to medication in CVD patients causes hospitalization, worsened symptoms, higher healthcare costs, and more emergency visits. Hence, this study aimed to assess treatment satisfaction and medication adherence and predictors in heart failure (HF) patients attending Debre Berhan Comprehensive Specialized Hospital (DBCSH), Ethiopia.

Methods

A hospital-based cross-sectional study was undertaken at the medical referral clinic of DBCSH. A total of 344 ambulatory HF patients who visited the medical care of the DBCSH medical referral clinic during the study period were included. Treatment satisfaction was assessed using a self-administered Medicine Questionnaire (SATMED-Q). Relationships between predictor variables and treatment satisfaction were determined using one-way analysis of variance (ANOVA) and an independent t-test. Medication adherence was determined using the Morisky Green Levin Medication Adherence Scale (MGLS).

Results

Participants with drug-drug interactions (DDIs) were approximately 38% less likely to adhere to medication compared to their counterparts (AOR = 0.62, 95% CI: 0.54-0.71). Additionally, participants who had taken five or more drugs were approximately 68% less likely to adhere to medication compared to those who had taken only one drug (AOR = 0.32, 95% CI: 0.2-0.51). The correlation between medication adherence and drug-drug interactions remains a possible pseudo-correlation via the number of medications taken. There was a noteworthy positive correlation (rs = 0.34, p = 0.027) between participants' treatment adherence and treatment satisfaction.

Conclusion

The rate of treatment satisfaction and treatment adherence among HF patients was 67.6% and 60.9%, respectively. The presence of DDI and the number of drugs were identified as predictors to medication adherence.

Pharmacist intervention to improve adherence to medication among heart failure patients at North East Ethiopia hospital

Heart failure (HF) is a major and growing medical problem and its management is still challenging due to the coexistence of complications, co-morbidity, and medication non-adherence. HF patients who are adherent to their medication have fewer HF exacerbations, improved survival, and lower healthcare expenditure. Adherence to HF medication plays a pivotal role in attaining maximal therapeutic outcomes. The aim was to assess the medication adherence of heart failure patients at Debre Berhan Comprehensive Specialized Hospital (DBCSH). A pre-post interventional study was undertaken from July 1, 2022, to December 31, 2022, at the medical referral clinic of DBCSH. The educational interventions were provided for 6 months. Medication adherence was determined using the Morisky Green Levin Medication Adherence Scale (MGLS). The data was entered into Epidata version 4.2.0 and analyzed using SPSS version 25.0 statistical software. Descriptive statistics and binary logistic regression analysis were performed. The strength of the association between predictor variables and outcome variables was determined using a 95% confidence interval and adjusted odd ratio. In the pre-intervention phase, 54.6% of patients had medium medication adherence, while in the post-intervention phase, 36.4% of patients had high medication adherence and 61.9% of patients had medium medication adherence. Following the intervention, medication cost (120, 50%), inadequate availability of drugs (75, 31%), and forgetfulness (30, 13%) were the main reasons for medication non-adherence. The presence of co-morbidity and the number of co-morbidity (p < .05) were significantly associated with the occurrence of decreased medication adherence in the pre-intervention phase. Interventions by pharmacists to educate HF patients about the nature of their disease and providing brochures to increase awareness of their medications have been shown to improve medication adherence.

Self-care behaviour and associated factors among heart failure patients in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

This study aimed to estimate the pooled level of self-care behaviour among heart failure patients in Ethiopia.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

PubMed/MEDLINE, HINARI, Web of Sciences, Scopus, Google Scholar, Science Direct, African journals online and University repositories were searched from 1 January 2000 to 1 November 2023.

ELIGIBILITY CRITERIA

We include studies that examined self-care behaviour among heart failure patients, studies that report factors associated with self-care behaviour and observational studies (cross-sectional, case-control and cohort) with full text available.

DATA EXTRACTION AND SYNTHESIS

The data were extracted with Microsoft Excel and analysed by using STATA V.11 software. The weighted inverse variance random-effects model at 95% CI was used to estimate the pooled level of self-care behaviour and its associated factors among heart failure patients. Tests of heterogeneity, test of publication bias and subgroup analyses were also employed.

RESULTS

Thirteen cross-sectional studies with 4321 study participants were included; and the pooled level of good self-care behaviour among heart failure patients in Ethiopia was found to be 38.3% (95% CI 31.46 to 45.13). Only 68.8% of heart failure patients were knowledgeable about heart failure. Knowledge about heart failure (Adjusted Odds Ratio (AOR)=3.39; 95% CI 2.42 to 4.74) and absence of comorbidity (AOR=2.69; 95% CI 1.35 to 5.37) were significantly associated with good self-care behaviour among heart failure patients in Ethiopia.

CONCLUSION

The majority of heart failure patients in Ethiopia did not adhere to the recommended self-care behaviours. Nearly one-third of heart failure patients were not knowledgeable about heart failure. Knowledge about heart failure and the absence of comorbidities were significantly associated with good self-care behaviour. Therefore, efforts should be devoted to increasing knowledge and preventing comorbidities among heart failure patients.

PROSPERO REGISTRATION NUMBER

CRD42023394373.

Heart failure drug classes and 30-day unplanned hospital readmission among patients with heart failure in Ethiopia

BACKGROUND

Drug therapy is a crucial aspect of heart failure management and has been shown to reduce morbidity and mortality in heart failure patients. However, the comparative effects of these drug classes on readmission rates have not been well studied. Therefore, the aim of this study was to examine the association between different classes of heart failure drugs and 30-day readmission rates in patients with heart failure.

METHOD

A multicenter, hospital-based retrospective cohort design was employed and 572 randomly selected patients with heart failure were included. Data were entered in Epi-data version 4.6 and analyzed with STATA version 17. Kaplan-Meier and log-rank tests were used to estimate and compare survival time. A Cox proportional hazard model was utilized, employing both bi-variable and multi-variable analyses, to examine the effect of predictors on the timing of unplanned hospital readmissions. The strength of the association was assessed using an adjusted hazard ratio (aHR), and statistical significance was declared for p-values < 0.05 and a 95% confidence interval (CI).

RESULTS

In this study, a total of 151 (26.40%) heart failure patients were readmitted within 30 days of discharge. In the multivariate cox proportional hazards analysis being an age (> 65 year) (AHR: 2.34, 95%CI: 1.63, 3.37), rural in residency (AHR: 1.85, 95%CI: 1.07, 3.20), hospital stays > 7 Days (AHR: 3.68, 95%CI: 2.51,5.39), discharge with Diuretics (AHR: 2.37, 95%CI: 1.45, 3.86), and discharge with Beta-Blocker (AHR: 0.48, 95%CI: 0 0.34, 0.69) were identified as independent predictors of unplanned hospital readmission.

CONCLUSION

Elderly patients, being in rural areas, longer hospital stays, and discharges of patients on diuretics and not on beta-blockers were independent predictors of unplanned hospital readmission. Therefore, working on these factors will help to reduce the hazard of unplanned hospital readmissions, improve patient outcomes, and increase the efficiency of heart failure management.

Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study

Background and objectives: The chronic nature of heart failure requires long-lasting consumption of various medications. Despite the therapeutic benefits of heart failure medications, about 50% of patients with heart failure don't adequately adhere to their medications as prescribed globally. This study aimed to determine medication adherence levels among Jordanians with heart failure and its influencing factors. Materials and Methods: A cross-sectional study was conducted among 164 patients with heart failure attending cardiac clinics in the north of Jordan. The Medication Adherence Scale was used to measure medication adherence. Results: Overall, 33.5% of patients had high adherence, and 47% had partial to poor adherence. The proportion of patients with good to high adherence was significantly higher among patients younger than 60 years, having >high school level of education, being married, living with somebody, and having insurance. Conclusions: Patient-centered approach, targeting age, level of education, marital status, and health insurance coverage, should be developed using evidence-based guidelines to enhance adherence to medication and health outcomes in Jordanian patients with heart failure. The development and implementation of new and feasible strategies, particularly suited to Jordan's healthcare system capabilities, is important to improve medication adherence.

Experiences of Facilitators and Inhibitors to Treatment Adherence in Patients with Heart Failure

Treatment adherence is a fundamental aspect of heart failure (HF) management. This study aimed to explore the experiences of facilitators and inhibitors of treatment adherence in patients with HF. This descriptive qualitative study was conducted from May 2020 to June 2021. Participants including people with HF, their family caregivers and physicians, and nurses were selected purposefully, with the aim of obtaining sufficient information power. Semi-structured interviews were used to collect data. Data were analyzed using thematic analysis. Two main themes "the driving forces behind treatment adherence" and "the deterrent forces behind treatment adherence" emerged from the analysis. The first theme contained the following subthemes: "supportive family," "positive personality characteristics," and "having health literacy." The second theme consisted of "negligence," "psychological problems," "cultural, social, and economic problems," "physical limitations," and "lack of self-care management knowledge." Nurses can consider facilitators and inhibitors of treatment adherence in designing educational and care programs for patients with HF.

Effectiveness of Yiqi Fumai lyophilized injection for acute heart failure: Rationale and design of the AUGUST-AHF cohort study

Introduction

The effect of Yiqi Fumai lyophilized injection (YQFM) on acute heart failure (AHF) patients has been evaluated in a large sample, randomized, controlled trial (AUGUST-AHF RCT study). However, restrictive eligibility criteria from a randomized clinical trial may raise concerns about the generalizability of the results to under-represented groups or complex patients with multimorbidity. Therefore, we intend to conduct the AUGUST-AHF cohort study which aims to assess the effectiveness of YQFM in patients with AHF in a real-world setting and compare the results with AUGUST-AHF RCT study.

Methods and analysis

This prospective, multicenter cohort study will be conducted at 50 secondary and tertiary hospitals in China and comprise 1,200 patients with AHF. The participants will be followed for up to at least 180 days. The primary outcome is a composite of 90-day all-cause mortality or readmission for heart failure. The secondary outcomes include length of hospital stay, cardiac-specific death, MACE, NYHA cardiac function classification. Cox proportional-hazards regression models will be used to estimate the association between YQFM use and the primary outcome. The primary analysis will use propensity-score matching methods to balance the differences in baseline variables between treatment cohorts.

Ethics and dissemination

Approval for the study has been obtained from the Ethical Committee of Dongzhimen Hospital (approval No. 2022DZMEC-327-02) and registered at ClinicalTrials.gov (NCT05586048). The study results will be published in peer-reviewed journals and presented at scientific conferences.

Assessment of Adherence to Cardiovascular Medicines in Saudi Population: An Observational Study in Patients Attending a Tertiary Care Hospital

BACKGROUND

Drug adherence has been extensively evaluated in many developed countries in the West using different methods of medication adherence measurement; however, there are relatively few reports studying the adherence levels among Saudi patients. Thus, this study will evaluate the adherence to cardiovascular medicines in Saudi patients visiting (PSCC) in Al-Qassim, Saudi Arabia.

METHODS

This cross-sectional observational study relied on self-administered questionnaires. This study used the Morisky, Green, and Levine (MGL) Adherence Scale, also known as the MAQ (Medication Adherence Questionnaire), in PSCC's pharmacy waiting room in Qassim, Saudi Arabia.

RESULTS

This study included 993 PSCC pharmacy waiting room patients. The patients were between 11 and 50 years old, and 52.7 percent were male. Most participants (71.2%) were above 50, while 16.3% were 41-50. Non-adherent patients cited traveling or being busy (28.6%), forgetting (18.7%), daily multi-medications (7.1%), being sleepy or sleeping (6.6%), and not repeating the prescription (6.6%). The Medicine Adherence Questionnaire indicated that 62.6 percent of patients fully adhered to their medications, and 21.6 percent usually adhered. Only drug adverse effects affected adherence (p =0.0001).

CONCLUSION

The current study showed that there is a good level of adherence among patients with cardiovascular diseases toward their diseases. The most common reasons for neglecting medications include traveling or being busy, forgetting multiple medications, and being tired or sleeping. Having experience with side effects was the only significant factor affecting adherence to medications.

An audit of Heart failure management among ambulatory adult patients at Queen Elizabeth Central Hospital (QECH), Malawi

Background

There are limited data on the clinical characteristics and use of guideline directed medical therapy among patients with heart failure in Malawi. We conducted a study to assess patient characteristics and clinical management given to heart failure patients at Queen Elizabeth Central hospital in Malawi.

Methods

In a cross sectional study, patients with a diagnosis of heart failure who were followed up in the adult chest clinic at QECH were recruited to ascertain their characteristics and the therapy they were receiving. Echocardiograms and electrocardiograms were performed to identify abnormalities.

Results

A total of 79 patients were recruited and 62% (49 out of 79) were female. The median age was 60 years (IQR 40.5-70.5). Most patients were hypertensive with NYHA (New York Heart Association) class I and II symptoms. Left ventricular(LV) systolic dysfunction was found in 55% (36 out of 65), with 68% (39 out of 65) having features of left ventricular remodeling. Most patients were on at least a single neurohormonal drug with 77% (61 out of 79) on ACEI (angiotensin converting enzyme inhibitor), 52% (42 out of 79) on a beta blocker and 34%(27 out of 79) on aldosterone antagonists. The recommended doses of medications were achieved in 14% (9 out 61), 24% (10 out 42), 22% (6 out of 27) on ACEI, beta blockers and aldosterone antagonists respectively.

Conclusions

Hypertension is the commonest comorbidity in patients with heart failure, who are mostly females with NYHA class I or II symptoms. Most had LV remodeling changes and are on at least one neurohormonal antagonist but most remain sub optimally treated.

Factors affecting medication adherence among older adults using tele-pharmacy services: a scoping review

BACKGROUND

Medication adherence among older adults (aged 60 and above), particularly those with chronic conditions who take several medications, is critical, and tele-pharmacy services are a way to improve medication adherence. This study sought to determine the factors influencing medication adherence (MA) in older adults using tele-pharmacy services.

METHOD

The Joana Briggs Institute scoping review methodology was implemented. Searches were conducted in databases PubMed, Scopus, ProQuest, Web of Science, and Embase from 2000 to the present day, to identify both qualitative and quantitative studies focusing on the use of tele-pharmacy by older people. Factors impacting MA were extracted and analyzed into themes using a qualitative approach. A concept map was also designed summarising these factors.

RESULTS

Of 7495 articles obtained in the initial search, 52 articles met the inclusion criteria. The analysis resulted in 5 themes and 21 sub-themes representing factors that impacted MA with tele-pharmacy. These themes are divided broadly into technology and user related factors. Technology factors included design of the tele-pharmacy intervention, commercial aspects, and adherence measurement method. User factors included user-health constraints, behaviors and perceptions.

CONCLUSION

Industry, policymakers, and stakeholders should consider using tele-pharmacy services for improving medication adherence among older adults; however, ensuring interventions facilitate communication between patients and health care teams, and are accompanied by user training and support, is essential for technology uptake and effectiveness.

Medication Adherence and Blood Pressure Control Among Hypertensive Outpatients Attending a Tertiary Cardiovascular Hospital in Tanzania: A Cross-Sectional Study

Background

Notwithstanding the availability of effective treatments, asymptomatic nature and the interminable treatment length, adherence to medication remains a substantial challenge among patients with hypertension. Suboptimal adherence to BP-lowering agents is a growing global concern that is associated with the substantial worsening of disease, increased service utilization and health-care cost escalation. This study aimed to explore medication adherence and its associated factors among hypertension outpatients attending a tertiary-level cardiovascular hospital in Tanzania.

Methods

The pill count adherence ratio (PCAR) was used to compute adherence rate. In descriptive analyses, adherence was dichotomized and consumption of less than 80% of the prescribed medications was used to denote poor adherence. Logistic regression analyses was used to determine factors associated with adherence.

Results

A total of 849 outpatients taking antihypertensive drugs for ≥1 month prior to recruitment were randomly enrolled in this study. The mean age was 59.9 years and about two-thirds were females. Overall, a total of 653 (76.9%) participants had good adherence and 367 (43.2%) had their blood pressure controlled. Multivariate logistic regression analysis showed; lack of a health insurance (OR 0.5, 95% CI 0.3-0.7, p<0.01), last BP measurement >1 week (OR 0.6, 95% CI 0.4-0.8, p<0.01), last clinic attendance >1 month (OR 0.4, 95% CI 0.3-0.6, p<0.001), frequent unavailability of drugs (OR 0.6, 95% CI 0.3-0.9, p = 0.03), running out of medication before the next appointment (OR 0.6, 95% CI 0.4-0.9, p = 0.01) and stopping medications when asymptomatic (OR 0.6, 95% CI 0.4-0.8, p<0.001) to be independent associated factors for poor adherence.

Conclusion

A substantial proportion of hypertensive outpatients in this tertiary-level setting had good medication adherence. Nonetheless, observed suboptimal blood pressure control regardless of a fairly satisfactory adherence rate suggests that lifestyle modification plays a central role in hypertension management.

Relationship Among Treatment Adherence, Family Functioning, and Self-Care Agency in Colombian Patients With Cardiovascular Disease

BACKGROUND

Multiple factors affect treatment adherence in individuals with cardiovascular disease. However, information on the relationships among treatment adherence, family functioning, and self-care agency in these patients and their families is limited.

PURPOSE

This study was developed to determine the relationships among treatment adherence, family functioning, self-care agency, and sociodemographic variables in patients with cardiovascular disease. Self-care agency, as defined by Orem, is the dynamic process patients use to engage in their own healthcare that involves discerning and addressing factors that allow their making decisions that improve self-care abilities.

METHODS

This cross-sectional, observational-analytical study enrolled 151 adult patients with cardiovascular diseases who had undergone pharmacological and nonpharmacological treatments and 108 family members of these patients who had consented to participate. Measurements were performed using the "Questionnaire for measuring treatment adherence in patients with cardiovascular disease," the "Family Functioning Assessment Scale," and the "Self-care Agency Scale."

RESULTS

Of the 151 patients, 119 (78.8%) were assessed as having a low risk of nonadherence, 60 (39.7%) as having low family functioning, and 131 (86.8%) as having high self-care agency. Treatment adherence and self-care agency showed a moderate and significant correlation ( r = .66, p < .001). Similarly, treatment adherence and family functioning showed a low but significant correlation ( r = .35, p < .001). Moreover, significant multivariate associations were found among the variables of interest. Patients with a low risk of nonadherence were found to be more likely to have a secondary or postsecondary education, not to have vision or hearing problems, and to have a contributory affiliation mode with the health system or private health insurance. In addition, participants with moderate or high levels of family functioning were less likely to be workers or to not have hearing or vision problems. Finally, significant differences were noted between patients with low self-care agency and those with high self-care agency in terms of kinship relationship with family members and affiliation mode with the health system.

CONCLUSIONS/IMPLICATIONS FOR PRACTICE

The results of this research help clarify the issue of treatment adherence in patients with cardiovascular disease. Although family functioning and self-care agency were found to be low to moderately correlated with treatment adherence, relevant information regarding these variables and sociodemographic variables is presented in this study. Nurses may use these results as a reference to design nursing care plans and interventions to address the conditions of their patients more appropriately.

Medication Adherence and Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran

Background:

Heart failure is a costly condition with high morbidity and mortality rates in low- and middle-income countries. Nonadherence to prescribed therapies can lead to severe problems such as poorer health outcomes, higher health care expenditures, increased hospitalizations, and even higher mortality rates in patients with advanced heart disease.

Objective:

The aim of the present study is to investigate medication adherence and the association between medication adherence and health literacy in Iranian patients with heart failure.

Methods:

This study was conducted in the heart failure outpatient clinic of Shahid Rajaee Cardiovascular, Medical, and Research Center in Tehran, Iran. Medical records and validated questionnaires were used to collect the necessary information on the survey variables, including sociodemographic characteristics, medication adherence, and health literacy, for a total of 250 patients with heart failure. Stepwise logistic regression analysis was performed to identify the variables that independently and significantly predicted medication nonadherence.

Key Results:

The results showed that most patients with heart failure had low medication adherence. Some factors, including gender, health literacy, and duration of illness, were associated with adherence. The study results showed a positive association between higher health literacy and better medication adherence.

Conclusion:

In view of the results, further studies on heart failure are needed to investigate other factors related to medication adherence and health literacy level to achieve better disease management and improve patients' treatment adherence. [HLRP: Health Literacy Research and Practice. 2022;6(3):e191–e199.]

Plain Language Summary:

This study investigated the relationship between medication adherence and health literacy in Iranian patients with heart failure. The results showed that most patients had inadequate health literacy. Moreover, it showed a significant and positive relationship between health literacy and medication adherence.

Adherence to self-care recommendations and associated factors among adult heart failure patients in public hospitals, Addis Ababa, Ethiopia, 2021: cross-sectional study

BACKGROUND

Adherence to self-care recommendations in heart failure (HF) patients is essential to improve the patients' quality of life, prevent hospital admission, and reduce mortality and morbidity. Nevertheless, poor adherence to self-care recommendations remains to be an extensive problem for HF patients. Thus, the aim was to assess adherence to self-care recommendations and associated factors among HF patients in public hospitals, Addis Ababa, Ethiopia, 2021.

METHODS

An institutional-based cross-sectional study was conducted among adult HF patients from February 15 to April 15, 2021, in five public hospitals, in Addis Ababa, Ethiopia. A total of 294 adult HF patients completed an interviewer-administered questionnaire in the Amharic language. The Revised HF Compliance Questionnaire was used to measure the adherence to self-care recommendations of HF patients. Data was collected using the Revised HF Compliance Questionnaire, the Japanese heart failure knowledge scale, the multidimensional scale of perceived social support, and the chronic diseases self-efficacy scale. Study participants were selected through a systematic random sampling technique. Data were entered into Epi-info version 7.1 and then exported to SPSS Version 25 for analysis. Descriptive and logistic regression analyses were performed and the statistical significance of associations between the variables was determined using ORs with 95% CI and p-values < 0.05.

RESULTS

Adherence to self-care recommendations among adult HF patients in public hospitals, in Addis Ababa, Ethiopia was 32.70%. Being female (AOR 4.66, 95% CI 1.58-13.67), patients who had high family monthly income (AOR 10.32, 95% CI 2.00-5.13), NYHA class III (AOR: 7.01, 95% CI 2.18-22.57) and class IV (AOR: 6.30, 95% CI 1.01-39.22), who had good self-efficacy (AOR 7.63, 95% CI 2.64-21.97), and who had good knowledge about HF (AOR 3.95, 95% CI 1.56-9.95) were more likely to have good adherence to self-care recommendations, p-value < 0.05.

CONCLUSION

This study revealed that 32.70% of adult HF patients had good adherence to self-care recommendations. Factors associated with adherence to self-care recommendations of adult HF patients are sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF. Therefore, interventions focused on sex, family monthly income, NYHA classification, self-efficacy, and knowledge about HF are required to improve adherence to self-care recommendations of adult HF patients.

Prognostic value of patient-reported outcomes in predicting 30 day all-cause readmission among older patients with heart failure

AIMS

Previous prediction studies for 30 day readmission in patients with heart failure were built mainly based on electronic medical records and rarely involved patient-reported outcomes. This study aims to develop and validate a nomogram including patient-reported outcomes to predict the possibility of 30 day all-cause readmission in older patients with heart failure and to explore the value of patient-reported outcomes in prediction model.

METHODS AND RESULTS

This was a prospective cohort study. The nomogram was developed and internally validated by Logistic regression analysis based on 381 patients in training group from March to December 2019. The nomogram was externally validated based on 170 patients from July to October 2020. Receiver operating characteristic curves, calibration plots and decision-curve analysis were used to evaluate the performance of the nomogram. A total of 381 patients' complete data were analysed in the training group and 170 patients were enrolled in the external validation group. In the training group, 14.4% (n = 55) patients were readmitted to hospitals within 30 days of discharge and 15.9% (n = 27) patients were readmitted in the external validation group. The nomogram included six factors: history of surgery, changing the type of medicine by oneself, information acquisition ability, subjective support, depression level, quality of life, all of which were significantly associated with 30 day readmission in older patients with heart failure. The areas under the receiver operating characteristic curves of nomogram were 0.949 (95% CI: 0.925, 0.973, sensitivity: 0.873, specificity: 0.883) and 0.804 (95% CI: 0.691, 0.917, sensitivity: 0.778, specificity: 0.832) respectively in the training and external validation groups, which indicated that the nomogram had better discrimination ability. The calibration plots demonstrated favourable coordination between predictive probability of 30 day readmission and observed probability. Decision-curve analysis showed that the net benefit of the nomogram was better between threshold probabilities of 0-85%.

CONCLUSIONS

A novel and easy-to-use nomogram is constructed and demonstrated which emphasizes the important role of patient-reported outcomes in predicting studies. The performance of the nomogram drops in the external validation cohort and the nomogram must be validated in a wide prospective cohort of HF patients before its clinical relevance can be demonstrated. All these findings in this study can assist professionals in identifying the needs of HF patients so as to reduce 30 day readmission.

Effect of the Implementation of Interdisciplinary Discharge Planning on Treatment Adherence and Readmission in Patients Undergoing Coronary Artery Angioplasty

OBJECTIVES

To determine the effect of interdisciplinary discharge planning on treatment adherence and readmission in the patients undergoing coronary artery angioplasty in the south of Iran in 2020.

METHODS

This experimental study had an intervention group and a control group with pre-test and post-test. 70 patients participated in the study who were randomly divided into the groups (intervention group (n=35) and control group (n=35)). In the intervention group, discharge planning was performed based on an interdisciplinary approach. Treatment adherence before, immediately, and one month after the intervention was evaluated with a 10-question survey scored from 1 to 5 (maximum score = 50), as well as readmission three months after the discharge was examined in both groups.

RESULTS

Before the intervention, there was no statistically significant difference between the intervention and the control groups in the treatment adherence score (18.22 versus 17.37; p=0.84) but immediately and one month after the intervention statistically significant differences between the groups were showed (21.51 versus 46.14 and 23.28 versus 43.12, respectively; p<0.001). Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group. Within three months after discharge, the readmission rate was 11.4% in the control group, while no readmission was reported in the intervention group.

CONCLUSIONS

The implementation of interdisciplinary discharge planning had positive effects on treatment adherence and readmission rate in patients undergoing coronary artery angioplasty; therefore, it is suggested that health care system managers make the necessary plans to institutionalize this new educational approach for other patients discharge planning.

Using the Health Belief Model to Explain the Patient's Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

BACKGROUND

Hypertension remains a public-health challenge globally. Its prevention, early detection, proper and adequate treatment and control should be given high consideration to prevent occurrence of cardiovascular disease and stroke. This study is guided by the Health Belief Model (HBM) to investigate the influence of treatment compliance using HBM constructs among elderly hypertensive patients in 3 regional hospitals in Dar es Salaam, Tanzania.

METHODS

An analytical cross-sectional study was conducted in 3 region hospitals in Dar es Salaam from April to May 2012. The study included patients who were on antihypertensive medications. Simple Random Sampling was used to enrol the study participants. Data was collected using structured questionnaire. Data was analysed using SPSS version 20. Linear Multiple Regression analysis was performed to identify variables which are strongest predictor of treatment compliance among variables of the Health belief Model.

RESULTS

A total of 135 participants were enrolled of whom 56% were compliant to hypertensive treatment. Multivariate analysis indicated significant model fit for the data (F=11.19 and P value <.001). The amount of variance in treatment compliance that was explained by the predictors was 30.3% (R2=0.303) with perceived barrier being the strongest predictor of treatment compliance (β=-0.477; p< .001). Other predictor variables were not statistically associated with treatment compliance.

CONCLUSION

The study showed that 56% of study participants had hypertensive treatment compliance and perceived barrier to treatment was the strongest predictor. Innovative strategy on improving patients' perception of barrier to treatment is recommended in order to improve treatment compliance.

Health behaviours and beliefs among Malawian adults taking antihypertensive medication and antiretroviral therapy: A qualitative study

In order to understand HIV-positive Malawian adults' experiences with hypertension management, we conducted qualitative interviews with 30 hypertensive adults who were also taking antiretroviral therapy. These interviews regarding hypertension management behaviours and beliefs were audio-recorded, transcribed, translated into English, and coded in Atlas.ti. Despite acknowledging the dangers of hypertension and the benefits of medication, many respondents missed their antihypertensive medication. Primary reasons included feeling healthy, health workers' advice to stop taking medicine when blood pressure normalised, side effects, and using herbs or non-prescription medicines to manage hypertension. Women highlighted difficulties with dietary modifications, and changes in their social relationships. Both men and women spoke about hypertension-related challenges with employment and household economics. These results suggest numerous challenges among adults managing hypertension and HIV in Malawi, and frequent suboptimal adherence to medication. We identified new key themes - the quality of adherence counselling for antihypertensive medication, the effects of hypertension on financial stability, and the role of social relationships in self-care - and encourage further investigation into these topics in low-income, high-burden countries.

Rheumatic Heart Disease Patients' Adherence to Secondary Prophylaxis and Associated Factors at Hospitals in Jimma Zone, Southwest Ethiopia: A Multicenter Study

BACKGROUND

Rheumatic heart disease (RHD) is a major cause of preventable premature cardiovascular-related death in developing countries. However, information regarding adherence rates and associated factors is limited and inconsistent in Ethiopia.

METHODS

A cross-sectional study was conducted from August to November 2019 among selected RHD patients on follow-up at four hospitals in Jimma zone. Data were collected using a structured questionnaire. Adherence of RHD patients to secondary prophylaxis in the previous consecutive 12 months was assessed based on the annual frequency of received prophylaxis (monthly injection of benzathine penicillin). Good adherence was considered the patient receiving >80% of the annual dose. The collected data were entered into Epidata 3.1 and analysed using SPSS 23.

RESULTS

A total of 253 RHD patients taking prophylaxis were included in the analysis, and of those 178 (70.4%) were female, giving a male:female ratio of 1:2.4. The mean age was 24±11 (6-65) years. About 63% had good adherence to benzathine penicillin prophylaxis. New York Heart Association functional class I and II, rural residence, >30 km from health facility, and duration of prophylaxis >5 years were associated with poor adherence (respectively: AOR 12.6 [95% CI 2.5-63], P=0.016; AOR 6.8 [95% CI 1.9-24.4], P=0.003; AOR 5.5 [95% CI 1.2-26.7], P=0.046; AOR 1.2 [95% CI 1.1-3.2], P=0.021). Leading barriers to good adherence were long distance from the treatment setting (56.9%), followed by lack of money (38%).

CONCLUSION

Patients with class I and II heart failure and those living in rural areas, especially >30 km from a hospital, were identified to be poorly adherent to secondary prophylaxis.