IDF21-0436 Pharmacotherapy, adherence to medications and quality of life among diabetic patients with heart failure

Abstract

Background: Patients with heart failure (HF) and diabetes mellitus (DM) have poorer clinical outcomes than patients with HF without DM. These patients may experience a striking deterioration, frequent hospitalizations, and increased all-cause mortality. Adherence to effective pharmacotherapy influences their quality of life (QOL). Aim: The objectives of this study were to evaluate the patterns of pharmacotherapy, assess factors affecting adherence to medication and quality of life (QOL) in diabetic patients with heart failure in an Indian tertiary care hospital setting. Method: We conducted a cross sectional study among patients with Type 2 Diabetes mellitus (T2 DM) and heart failure in an Indian tertiary care hospital from April 2018 to March 2020 after obtaining the informed consent (IEC approval No 82/2018). Data on sociodemographic characteristics, clinical features, pharmacotherapy, adherence to medication (Adherence and refills to medication scale) and quality of life (EQ 5D-3L) were collected prospectively by record review and patient interview. Data were analysed by independent samples t test, chi square test and multiple logistic regression analysis using SPSS 26.0. Results: We included 125 patients with Type 2 Diabetes mellitus (T2 DM) and heart failure. The mean age was 60.2 ±9.45 years with a male preponderance (74%). Smoking was noticed in 84% of patients and alcohol use in 57%. About 58% had other comorbidities, with hypertension in 58%. Mean HbA1C was 8.28±1.04. About 45% had a reduced ejection fraction (EF) and 55% had preserved EF. Polypharmacy was noted in 90%. The five most common drug classes used were diuretics (95%), antihypertensives (90%), antiplatelets (90%) insulin (78%), and statins (67%). Oral hypoglycaemic were used by 40%. Beta blockers were prescribed in 28% of patients. The most common adverse outcome was end stage renal disease (17%). Poor adherence to medications was noted in 54% of patients. Poor educational status <12th standard (38.8% vs 55.1%) and lower mean monthly income (15586.21±1874.79 vs 22044.78±1957.07) were noticed among those with overall poor adherence (p<0.05). On multivariate analysis, poor educational status (OR= 0.16, CI= 0.070-0.365, p<0.001) was noticed as an important predictor for poor adherence. Overall poor mean QOL score (0.67 ±0.22) was noticed in patients with type 2 DM and HF. Alcohol use (OR= 3.64, CI= 1.603-8.301, p= 0.002), chewable tobacco use (OR= 2.39, CI=1.030-5.549,P=0.04) and low overall health scale score (OR= 1.06, CI= 1.024-1.099, p<0.001)) were noticed as predictors of poor QOL. Discussion: Diabetic patients with congestive heart failure were found to have a male preponderance, multiple comorbidities, polypharmacy, poor adherence to medications, and an overall poor QOL score. Utilization of diuretics, antihypertensives, antiplatelets, insulin, and statins were noticed in most patients. Poor educational status and lower mean monthly income were associated with poor medication adherence. Alcohol and chewable tobacco usage and lower health scale scores were noticed as predictors poor QOL.