Association of hs-CRP Levels and Medications Adherence Status among Heart Failure Patients at a Cardiac Referral Hospital in Tanzania

Abstract

Introduction: Heart Failure (HF) is a global health problem, and despite much progress in new therapies, its prognosis remains poor. This is due to a number of factors including lack of adherence to HF medications. Previous studies have shown high sensitivity C-reactive protein (hsCRP) to change with HF progression, and that plasma hsCRP levels can be used to predict HF progression and assessment of adherence to medications. This association however has not been studied in Sub-Saharan African (SSA) countries, including Tanzania. Aim: To study the association between hsCRP levels and HF medications adherence among HF patients attending the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania. Materials and Methods: This was a hospital based cross-sectional study, where all eligible adult HF patients were consecutively enrolled as they attended their regular clinics, until the sample size was reached. Patients’ socio-demographic and clinical information was collected through interviews and chart reviews. An 8-item Morisky tool was used to assess patients’ adherence to HF medications. Blood was collected and analysed for hsCRP, Complete Blood Count (CBC) and cholesterol panel. hsCRP was considered elevated when it was >5 mg/L. Data were analysed using Statistical Package for Social Sciences (SPSS) computer software, version 21. All tests were 2-sided, and a p-value of <0.05 was considered to indicate a significant association. Results: In total, 210 HF patients were enrolled. Their mean age was 54±15.9 years and 53.8% were females. In the total population, the mean hsCRP was 7.15±4.94 mg/L, and 122 (58.1%) patients had elevated hsCRP. Poor medications adherence was present in 138 (65.7%) patients. Patients with poor medications adherence were more likely to have elevated hsCRP levels (68.1%) when compared to patients with good adherence (38.9%), p<0.001. In multivariate logistic regression analysis, elevated hsCRP independently predicted poor medications adherence (OR=4.27, 95% CI 2.14-8.51, p<0.001), irrespective of other variables. Conclusion: HF patients with poor medications adherence are 4-times more likely to have elevated hsCRP, irrespective of other clinical and socio-demographic factors in this study cohort. These findings suggest that hsCRP levels can be considered as surrogate to HF medications adherence.