Abstract 18245: Results of the Chronic Heart Failure Intervention to Improve Medication Adherence (CHIME) Study: A Randomized Self-Management Intervention in High Risk Non-Adherent Patients

Abstract

Background: Heart failure (HF) remains a primary cause of avoidable hospitalizations, disability and death. Taking evidenced-based medications is one component of guideline-based self-management, and is associated with improved clinical outcomes. Despite benefits, patients struggle with medication adherence in daily life and adherence remains less than 50%. Interventions to improve medication adherence have been limited in their ability to show an effect over time. Purpose: To evaluate the efficacy of a self-management intervention designed to develop person-centered symptom identification and to improve symptom response and medication adherence in high-risk persons with HF. Methods: Patients with HF and at high risk for non-adherence (n=84) were randomized to an attention control or the intervention. A prospective, randomized controlled design was used to pilot test the efficacy of an intervention to promote adherence to the medication regimen in high risk patients with chronic heart failure. The intervention was administered at 3 month intervals by a nurse over the phone with a focus on skill-based teaching for symptom recognition and rapid response, medication adherence strategies, and self-management activities. Longitudinal analysis was performed to evaluate the magnitude of change in adherence and symptom-related events at 3, 6 and 12-month clinic visits. Efficacy was measured as improved adherence using the Morisky adherence scale and pill count. Results: Patients in the intervention arm were almost four times as likely to be adherent to medications at 12 months as compared to attention control (OR 3.92; 95% C.I. 1.83, 8.40; p= .0006). Symptom recognition; accuracy and timeliness of medication reconciliation; appointment keeping; and caregiver engagement scores were improved in the intervention group. Readmissions and emergency department use were not statistically different. Conclusions: A nurse administered self-management intervention that includes a symptom recognition and response plan component improves medication adherence and shows a trend in decreased hospitalizations.