Abstract
This study evaluated the adherence to prescribed cardiovascular therapy medications among cardiovascular disease patients attending clinics in Misan, Amara, Iraq. Mixed methods were used to assess medication adherence comprising the Arabic version of the eight-item Morisky Medication Adherence Scale (MMAS-8) and determination of drug concentrations in patient dried blood spot (DBS) samples by liquid chromatography-high resolution mass spectrometry. Three hundred and three Iraqi patients (median age 53 years, 50.5% female) who had been taking one or more of the nine commonly prescribed cardiovascular medications (amlodipine, atenolol, atorvastatin, bisoprolol, diltiazem, lisinopril, losartan, simvastatin and valsartan) for at least six months were enrolled. For each patient MMAS-8 scores were determined alongside drug concentrations in their dried blood spot samples. Results from the standardized questionnaire showed that adherence was 81.8% in comparison with 50.8% obtained using the laboratory-based microsample analysis. The agreement between the indirect (MMAS-8) and direct (DBS analysis) assessment approaches to assessing medication adherence showed significantly poor agreement (kappa = 0.28, P = 0.001). The indirect and direct assessment approaches showed no significant correlation between nonadherence to prescribed cardiovascular pharmacotherapy and age and gender, but were significantly associated with the number of medications in the patient’s treatment regimen (MMAS-8: Odds Ratio (OR) 1.947, 95% CI, P = 0.001; DBS analysis: OR 2.164, 95% CI, P = 0.001). The MMAS-8 results highlighted reasons for nonadherence to prescribed cardiovascular pharmacotherapy in this patient population whilst the objective DBS analysis approach gave valuable information about nonadherence to each medication in the patient’s treatment regimen. DBS sampling, due its minimally invasive nature, convenience and ease of transport is a useful alternative matrix to monitor adherence objectively in Iraq to cardiovascular pharmacotherapy. This information combined with MMAS-8 can provide clinicians with an evidence-based novel approach to implement intervention strategies to optimise and personalise cardiovascular pharmacotherapy in the Iraqi population and thereby improve patient health outcomes.
Highlights
Cardiovascular diseases (CVD) cover disorders of the blood vessels and heart and include hypertension, angina, heart attack, and stroke
Given the high humanistic and economic cost associated with nonadherence to prescribed CVD pharmacotherapies the assessment of adherence is a crucial step to ensure that clinicians make an informed clinical decision about treatment and that patients derive the full benefits of the prescribed pharmacotherapy and reduce medicines wastage and costs for healthcare services
This study showed that only 50.8% of the Iraqi volunteers were adherent to one or more of their prescribed CVD medications when assessed using the analysis of patient dried blood spot (DBS) samples in this patient population
Summary
Cardiovascular diseases (CVD) cover disorders of the blood vessels and heart and include hypertension, angina, heart attack, and stroke. There is evidence that as many as 50% of prescribed CVD medications are not taken by patients as recommended [8,9,10] This suboptimal adherence to prescribed CVD therapies can lead to substantial health consequences for patients and negative consequences for national healthcare systems because nonadherence reduces the effectiveness of the drug treatment and is associated with morbidity, mortality, medicines wastage, hospital admissions and higher costs of care [9, 11,12,13]. Given the high humanistic and economic cost associated with nonadherence to prescribed CVD pharmacotherapies the assessment of adherence is a crucial step to ensure that clinicians make an informed clinical decision about treatment and that patients derive the full benefits of the prescribed pharmacotherapy and reduce medicines wastage and costs for healthcare services
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