Introduction:Nonadherence to cardiovascular medicines is a major concern. It increases the morbidity and mortality of cardiovascular patients. The work was conducted to evaluate the adherence to cardiovascular medicines in patients of rural India.Methods:The study was conducted in the Department of Medicine involving rural patients with essential hypertension (HTN), congestive cardiac failure (CCF), and ischemic heart disease (IHD) over 12 months period. Patients were prescribed with cardiovascular medicines at the initial visit and adherence to medicines was assessed in the subsequent visit. Four items Morisky's Medication Adherence Scale (MMAS-4) was used for assessing medication adherence. Patients were considered adherent to medication if they answered negatively to all four questions.Results:Overall adherence to medication was 20.83%, 28.37% and 32% in HTN, CCF, and IHD patients, respectively. Nonadherence was highest in patients of HTN. Among the four reasons of nonadherence assessed by MMAS-4, carelessness was the most common and forgetfulness was the least common cause of nonadherence in all the three groups of patients.Conclusion:Patients of rural India adhere poorly to cardiovascular medicines. Nonadherence should be considered as a public health problem. Strategies for detecting the level of adherence of cardiovascular medicines, its barriers, and subsequent interventions should be developed by policy-makers to reduce morbidity and mortality due to cardiovascular disorders.
Background and Objectives: Palmar creases may become as pale as the surrounding skin in severe anemia. However, its sensitivity for assessing severe anemia is questionable, especially in Indian perspective. The study was conducted to evaluate the value of palmar creases in detecting severe anemia. Materials and Methods: Patients with laboratory confi rmed anemia were assessed for pallor of palmar creases without information of patient's hemoglobin (Hb) value to the observer. Sensitivity and specifi city of palmar creases pallor were assessed for severe anemia. Role of clinical signs such as severe pallor of conjunctiva, tongue and nail-beds and pulmonary ejection systolic murmur were also assessed for predicting severe anemia. Results: Of 200 patients, 50 had severe anemia (Hb <7 g/dL). Only six patients with Hb <7 g/dL were found to have creases looking similar pale to surrounding skin. Average Hb level of them was 4.05 ± 0.82 g/dL. No patients with Hb ≥7 g/dL had pale palmar creases. In severely anemic patients, its sensitivity is only 12%, but specifi city is 100%, and positive likelihood ratio is >1200. Severe pallor of conjunctiva, tongue and nail-beds and pulmonary ejection systolic murmur were more sensitive, but specifi city of them was less for severe anemia. Conclusions: Color of palmar creases is a poorly sensitive indicator of the severe anemia especially in Indians due to the pigmentation of creases. Hence, the absence of palmar crease pallor is not likely to be of use in ruling out severe anemia.
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