Medication Adherence In Heart Failure Patients Research Articles

Resilience mediates the effects of self‐care activation and hope on medication adherence in heart failure patients

Medication adherence is important to heart failure (HF) self-care. However, the rate of medication nonadherence is approximately 50%. Evidence suggests that self-care activation and hope may be internal motivators for medication adherence. Empirical data on the association between self-care activation, hope, and medication adherence among people with HF is sparse, and the mechanism by which these factors influence medication adherence is unclear. The findings of prior research studies suggest that resilience may help to explain the relationship between self-care activation, hope, and medication adherence. The aim of this cross-sectional study was to investigate whether resilience mediated the effects of self-care activation and hope on medication adherence. A total of 174 adults with HF, between the ages of 19 and 92, completed the Patient Activation Measure, The Adult Hope Scale, the 14-item Resilience Scale, and the Domains of Subject Extent of Nonadherence Scale. Mediation analyses revealed that resilience fully mediated the effects of self-care activation and hope on medication adherence. Clinicians should consider the person related factors of self-care activation, hope, and resilience when promoting medication adherence in people with HF. Resilience may play an important role in improving medication adherence in HF patients. More research is needed to understand the connection between resilience, self-care activation, hope, and medication adherence.

Effects of a multidisciplinary management program on symptom burden and medication adherence in heart failure patients with comorbidities: A randomized controlled trial

BackgroundComorbidities in heart failure (HF) are a complex clinical challenge. There is little data on the benefits of multidisciplinary postdischarge management programs in such patients. This study aimed to examine the effects of a multidisciplinary management program (MMP) on symptom burden and medication adherence in HF patients with comorbidities.MethodsIn this clinical trial study, 94 HF patients with comorbidities were assigned to intervention (n = 47) and control (n = 47) groups by the stratified-random method. The intervention group underwent MMP supervised by a nurse for two months after discharge, including multi-professional visits, telephone follow-ups, and an educational booklet. Medication adherence and symptom burden were assessed using Morisky Medication Adherence Scale (MMAS) and Edmonton Symptom Assessment Scale (ESAS), respectively, on three occasions: Before discharge, six weeks, and eight weeks after discharge.ResultsBoth groups almost matched at the baseline, and the most frequent comorbidities included myocardial infarction (MI), hypertension, peptic ulcer, and depression, respectively. The interactive effect of time in groups showed that mean changes in total scores of symptom burden and medication adherence were significantly different (P < 0.001) at other time points. A significant increase in medication adherence (P < 0.001) and a significant reduction in the burden of all symptoms were observed in the intervention group compared to the control group from Time 1 to Time 3.ConclusionsThe MMP (targeting comorbidity) is a promising strategy for managing symptoms and medication adherence in HF patients with comorbidities.

Abstract 217: Assessing Medication Non-Adherence In Heart Failure Patients: A Resident Driven Quality Improvement Initiative

Introduction: Non-adherence to guideline directed medical therapies (GDMT) is responsible for significant health care costs, morbidity, and mortality in heart failure (HF) patients. Assessing and improving medication adherence (MA) is challenging in this patient population given its multifactorial nature. We aimed to evaluate trainee assessment of MA in HF patients while identifying potential barriers to addressing MA during patient encounters. Methods: This was a single-institution study performed at a large safety net hospital in Atlanta. An anonymous questionnaire was used to assess MA strategies of interns, residents, and medical students for HF patients. This data was compiled and analyzed to identify the most commonly perceived barriers to medication non-adherence. Results: 100 surveys were returned. 99% (99/100) noted that addressing MA is important in HF patients. However, only 83% (83/100) reported that they discussed the specific reasons for non-adherence with their HF patients, with 9%, 12%, and 78% addressing MA in the outpatient, inpatient, and both settings, respectively; the lack of time was reported as the most common contributor in all settings. The most common reasons reported by trainees for patient non-adherence include misunderstanding of their regimen (71%), cost (62%), and polypharmacy (57%). Although, 40% (40/100) of survey responders believed that ≥50% of their HF patients were nonadherent, strikingly, only 12% (12/100) discussed these MA barriers at all HF patient visits. Conclusion: Improving outcomes in HF patients is multifactorial. Medicine teaching teams can play a crucial role in this process by recognizing and addressing the specific barriers to MA in HF patients while promoting GDMT adherence. Our study demonstrates that although trainees recognize the importance of MA, the unique patient characteristics that contribute to non-adherence are under appreciated. Our long-term goal is to not only identify these barriers, but to implement educational interventions, then re-assess trainee comfort level with discussing MA, to demonstrate that trainee driven interventions can improve MA in HF patients while simultaneously reducing HF related re-admissions and hospital costs.

A multi-component, family-focused and literacy-sensitive intervention to improve medication adherence in patients with heart failure–A randomized controlled trial

BackgroundMedication nonadherence is prevalent and links to serious outcomes (e.g., rehospitalization/death) in heart failure (HF) patients; therefore, an urgent need exists for an intervention to improve and sustain adherence after intervention completion. ObjectivesTo test the efficacy of a multi-component, family-focused, literacy-sensitive (FamLit) intervention on medication adherence in HF patients. MethodsForty-three HF patients and their care partners were enrolled and randomized to receive FamLit or attention-only intervention, including an in-person session at baseline and bi-weekly phone boosters for 3 months. We measured medication adherence from baseline to 3-month post-intervention using the Medication Event Monitoring System. ResultsAfter 3-month intervention, intervention patients had significantly better medication adherence than control patients. At 6 months (3-months post-intervention), intervention effect on adherence was sustained in the FamLit intervention group, while adherence decreased in the control group. ConclusionIncorporating care partner support and providing an easy-to-understand intervention to patients-care partners may improve/sustain adherence.

Abstract 12038: A Family-focused and Literacy-sensitive Intervention to Improve Medication Adherence in Patients With Heart Failure

Background: Medication nonadherence contributes to rehospitalization and death in heart failure (HF) patients, yet there is no intervention that improves and sustains adherence after intervention completion. Objective: To address the need for a more effective intervention, we combined a literacy sensitive approach that also incorporated family support in an educational counseling intervention. The purpose of the study was to pilot-test the effects of a fam ily-focused, lit eracy-sensitive ( FamLit ) intervention on improving and sustaining medication adherence in HF patients. Methods: A randomized controlled pilot trial was conducted on 43 HF patients and their family members (dyads) who were assigned to the FamLit intervention group or usual care attention-control group. All dyads had an in-person session at baseline and received bi-weekly phone booster calls for the 3 month intervention. The Medication Event Monitoring System (MEMS) was used to measure medication adherence continuously for 6 months (from baseline). Repeated measures analysis of variance (ANOVA) was used to analyze the data. Results: No differences on demographic and clinical factors between groups at baseline. After the intervention, patients in the FamLit group (n=24) had better medication adherence compared to the control group (n=19) as measured by the MEMS (84.96% vs. 79.9%). Repeated measures ANOVA showed that there was a significant group by time interaction (F=7.158, p=.011). Improvement of medication adherence was sustained from 3 to 6 months in the intervention group (84.96% to 84.67%, Figure) while medication adherence decreased in the control group (79.9% to 69.96%), reflecting the natural trajectory of medication adherence. Conclusion: Incorporating family support and providing easy-to-read educational material to both HF patients and their caregivers enhances medication adherence during the intervention and sustains adherence 3 months after intervention completion.

Self-reported versus ‘true’ adherence in heart failure patients: a study using the Medication Event Monitoring System

BackgroundAdherence to (non)pharmacological treatment is important in heart failure (HF) patients, since it leads to better clinical outcome. Although self-reported and objectively measured medication adherence in HF patients have been compared in previous studies, none of these studies have used an evidence-based cutpoint to differentiate between adherence and non-adherence.MethodsIn 37 HF patients (mean age 68 ± 10 years, 27 % female, 40 % NYHA functional class III-IV), medication (ACEi/ARB) adherence was objectively measured using the Medication Event Monitoring System (MEMS). Adherence to and importance of taking medication was also assessed by self-report using the Revised HF Compliance Questionnaire.ResultsAll patients reported that adherence was (highly) important to them and that they ‘always’ took their medication as prescribed (i.e. 100 % adherence). However, when measured by the MEMS, only 76 % of all patients were adherent. Non-adherent patients more often had a complex medication regimen (78 % vs. 21 %, P < .01), more often depressive symptoms (75 % vs. 29 %, P = .04) and a shorter history of HF (8 vs. 41 months, P = .04), compared with adherent patients.ConclusionsMedication adherence measured by the MEMS was remarkably lower than self-reported adherence. Given the evidence of its importance, further efforts are needed to improve adherence to the pharmacological regimen in HF patients.

Investigating a TELEmedicine solution to improve MEDication adherence in chronic Heart Failure (TELEMED-HF): study protocol for a randomized controlled trial

BackgroundFrequent rehospitalisations and poorer survival chances in heart failure (HF) patients may partly be explained by poor medication adherence. There are multiple medication-related reasons for suboptimal adherence, but psychological reasons may also be important. A novel TELEmonitoring device may improve MEDication adherence in HF patients (TELEMED-HF). TELEMED-HF is a randomized, controlled clinical intervention trial designed to examine (1) the efficacy and cost-efficiency of an electronic medication adherence support system in improving and monitoring HF patients' medication adherence; (2) the effect of medication adherence on hospitalizations and health care consumption; as well as on (3) clinical characteristics, and Quality of Life (QoL); and (4) clinical, sociodemographic, and psychological determinants of medication adherence.Methods/DesignConsecutive patients with chronic, systolic HF presenting to the outpatient clinic of the TweeSteden Hospital, The Netherlands, will be approached for study participation and randomly assigned (1:1) following blocked randomization procedures to the intervention (n = 200) or usual care arm (n = 200). Patients in the intervention arm use the medication support device for six months in addition to usual care. Post-intervention, patients return to usual care only and all patients participate in four follow-up occasions over 12 months. Primary endpoints comprise objective and subjective medication adherence, healthcare consumption, number of hospitalizations, and cost-effectiveness. Secondary endpoints include disease severity, physical functioning, and QoL.DiscussionThe TELEMED-HF study will provide us a comprehensive understanding of medication adherence in HF patients, and will show whether telemonitoring is effective and cost-efficient in improving adherence and preventing hospitalization in HF patients.Trial registration numberNCT01347528.

Application of Support Vector Machine for Prediction of Medication Adherence in Heart Failure Patients

ObjectivesHeart failure (HF) is a progressive syndrome that marks the end-stage of heart diseases, and it has a high mortality rate and significant cost burden. In particular, non-adherence of medication in HF patients may result in serious consequences such as hospital readmission and death. This study aims to identify predictors of medication adherence in HF patients. In this work, we applied a Support Vector Machine (SVM), a machine-learning method useful for data classification.MethodsData about medication adherence were collected from patients at a university hospital through self-reported questionnaire. The data included 11 variables of 76 patients with HF. Mathematical simulations were conducted in order to develop a SVM model for the identification of variables that would best predict medication adherence. To evaluate the robustness of the estimates made with the SVM models, leave-one-out cross-validation (LOOCV) was conducted on the data set.ResultsThe two models that best classified medication adherence in the HF patients were: one with five predictors (gender, daily frequency of medication, medication knowledge, New York Heart Association [NYHA] functional class, spouse) and the other with seven predictors (age, education, monthly income, ejection fraction, Mini-Mental Status Examination-Korean [MMSE-K], medication knowledge, NYHA functional class). The highest detection accuracy was 77.63%.ConclusionsSVM modeling is a promising classification approach for predicting medication adherence in HF patients. This predictive model helps stratify the patients so that evidence-based decisions can be made and patients managed appropriately. Further, this approach should be further explored in other complex diseases using other common variables.

Abstract 2233: Biobehavioral Factors and Heart Failure Medication Adherence

Background: Medication adherence in heart failure (HF) patients reduces hospitalizations and improves outcomes, yet it is variable. This study evaluated adherence rates and associated biobehavioral factors for two HF medications using objective (Medication Event Monitoring System; MEMS) and self-report approaches. Methods: The sample (n = 87) was primarily male (64.4%), Black (64.7%), NYHA class II (71%), married (56.9%) with left ventricular ejection fraction (LVEF) 26.6±14.2, age 55.5±10.4 years. Adherence for a HF medication and diuretic was monitored for 19.6 ±5.7 days using the MEMS. Relationships among clinical variables (NYHA class, LVEF, six-minute walk test [6MWT]; objective (MEMs) and self-reported (Morisky Medication Adherence Scale) medication adherence; medication self-efficacy (Perceived Self-Efficacy [SE] for Medication Compliance); medication taking self-regulation (Treatment Self-Regulation for Medication Taking); and HF knowledge (HF Knowledge Questionnaire) were analyzed using correlation coefficients and hierarchical multiple regression. Results: Adherence was 85.42% for the HF medication (n=74) and 83.42% (n=67) for daily diuretic. MEMS and Morisky scores were correlated for the HF medication (r=.389, p=.002) and diuretic (r=.392, p=.002). Medication SE was related to adherence for HF medication (r=.283, p=.025) and diuretic (r=.294, p=.028). Higher HF Knowledge Questionnaire scores were related to greater adherence for the HF medication (r=.316, p=.012) and diuretic (r=.359, p=.007). The model (marital status, HF knowledge, medication SE and 6MWT) yielded adj. R 2 =.26 (F =6.7, p&lt;.001;) with medication SE (p&lt;.001) and 6MWT (p=.053) as independent predictors of medication adherence. Clinical, demographic and medication self-regulation variables were not significant. Conclusions: Medication adherence in HF patients is related to modifiable factors of medication self-efficacy and HF knowledge. Improving medication self-efficacy, knowledge and showing patients tangible evidence of improvement in physical function such as increased 6MWT distance may lead to enhanced medication adherence.