Treatment fatigue among adult patients with chronic heart failure in a tertiary care hospital in Ethiopia: a mixed-methods study

Abstract

Background/Aims Patients with heart failure must adhere to strict treatment regimens, including pharmacological treatments, medical appointments and lifestyle modifications. This study aimed to assess the extent of treatment regimen fatigue among patients with heart failure in Ethiopia and identify factors that may exacerbate this. The authors also aimed to gather insights from patients and health professionals about how to ameliorate the impact of treatment regimen fatigue. Methods An explanatory sequential mixed-methods study was conducted at a specialist cardiac clinic in Ethiopia from 1 August to 30 September 2021. In the quantitative stage, the Treatment Regimen Fatigue Scale was delivered via interview to 325 patients with heart failure to collect data on their level of treatment regimen fatigue and analyse this against their demographic, clinical and treatment-related characteristics. The influences of factors on treatment regimen fatigue were tested using the Mann–Whitney U, Kruskal–Wallis and Chi square tests, as appropriate. In the qualitative stage, interviews were conducted with 14 patients with heart failure and 10 specialist health professionals to identify possible interventions to reduce treatment regimen fatigue. Interviews were recorded, transcribed and subject to content analysis to identify themes. Results In the quantitative phase, participants' mean level of treatment regimen fatigue was −48.38±13.1, indicating low levels of fatigue. Several factors had a significant impact on level of treatment regimen fatigue, including living alone (U=7819.5; Z=−3.01; P=0.003); poor knowledge of heart failure (U=4379.0; Z=−4.24; P<0.001); lack of family support (U=6152.5; Z=−4.09; P<0.01); presence of two or more comorbidities (U=11273.5; Z=−2.28; P=0.023); adverse drug effects (U=6990.0; Z=−2.78; P=0.006); poor availability of medications (U=10215.0; Z=−3.43; P=0.001); and reliance on health insurance to obtain medication (X2=7.18; P=0.028). Qualitative results indicated that improving patients' self-care, making changes to the structure of the cardiac clinic (eg more regular follow up with the same clinician) and improving the general healthcare system could reduce treatment regimen fatigue. Conclusions Patients with heart failure seem to experience low levels of treatment regimen fatigue, but this can be influenced by a variety of demographic, clinical and treatment-related factors. Interventions on a local and systemic level could reduce the risk of treatment regimen fatigue, but there is no one-size-fits-all solution.