Assessment of adherence to therapy and options for polypharmacy in patients with CHF according to local registry data

Abstract

Objective: to study the frequency of adherence to therapy, as well as options for existing polypharmacy in patients with chronic heart failure (CHF) according to local registry data.Materials and methods: the study included 398 patients with CHF aged 72.17±11.12 years. Patients were divided into groups depending on the type of polypharmacy (appropriate and inappropriate) according to the criteria of the EURO-FORTA (EF) system (2021) and based on national clinical guidelines (CR) (2020), without polypharmacy (taking 1–4 drugs during prehospital stage) who did not take therapy at the prehospital stage - during the last 3 months before the actual hospitalization.Results: depending on the type of polypharmacy at the outpatient stage, the analysis was carried out by comparing 4 groups: appropriate (n=103 (EF) and n=120 (CR)) and inappropriate (n=103 (EF) and n=86 (CR) polypharmacy, without polypharmacy (taking 1-4 drugs) (n=91 (EF) and n=117 (KR)) and not taking therapy at the prehospital stage (n=55 (EF) and n=75 (KR)) during the last 3 months before current hospitalization. According to the Morisky-Green questionnaire, 38.44% were adherent to treatment at the prehospital stage, possibly adherent — 7.28%, non-adherent — 54.28%. The lowest quality of pharmacotherapy at the prehospital stage was observed in the group of patients without polypharmacy: they were less likely than patients with appropriate and inappropriate polypharmacy (according to the CR criteria) to take angiotensin-converting enzyme inhibitors (ACEIs) (30.77% versus 55.00% versus 51.16 %, рmg=0.0001), β-adrenergic blockers (β-AB) (52.13% vs. 88.33% vs. 77.90%, рmg=0.0001) and mineralocorticoid receptor antagonists (MCRA) (11.11 % versus 57.50% versus 52.32%, рmg=0.0001) and quite often in 30.77% (p=0.00001) they took potentially unacceptable medications, which further reduced the quality of therapy.Conclusion: according to the Morisky-Green questionnaire, 54.28% of patients with CHF were non-adherent to therapy at the prehospital stage. Patients with CHF at the prehospital stage in 25.2% did not receive treatment for CHF, in 39.3% there was no polypharmacy and in 69.1% polypharmacy was observed. In multimorbid patients with CHF, polypharmacy had the following advantages: more frequent use of 3-component basic therapy for CHF, more frequent use of ACE inhibitors, β-blockers, AMCR, statins for coronary heart disease (CHD), oral anticoagulants (OAC) for fibrillation/flutter atria (AF/AFL) and antihyperglycemic therapy for diabetes mellitus (DM).