Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial

Granger, Bradi B.; Swedberg, Karl; Ekman, Inger; Granger, Christopher B.; Olofsson, Bertil; McMurray, John J.V.; Yusuf, Salim; Michelson, Eric L.; Pfeffer, Marc A.

doi:10.1016/s0140-6736(05)67760-4

Cited by 419 publications

(303 citation statements)

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“…Some studies suggest that chronic disease patients need to achieve 80 percent adherence to derive benefits from their medications. [14][15][16] We then defined a loss of adherence as being adherent in 2006 but being nonadherent in 2007. Similarly, we defined an increase in adherence as being nonadherent in 2006 and adherent in 2007.…”

Section: Study Data and Methodsmentioning

confidence: 99%

Greater Adherence To Diabetes Drugs Is Linked To Less Hospital Use And Could Save Nearly $5 Billion Annually

Jha

Aubert²,

Yao³

et al. 2012

Health Affairs

146

112

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Improving adherence to medication offers the possibility of both reducing costs and improving care for patients with chronic illness. We examined a national sample of diabetes patients from 2005 to 2008 and found that improved adherence to diabetes medications was associated with 13 percent lower odds of subsequent hospitalizations or emergency department visits. Similarly, losing adherence was associated with 15 percent higher odds of these outcomes. Based on these and other effects, we project that improved adherence to diabetes medication could avert 699,000 emergency department visits and 341,000 hospitalizations annually, for a saving of $4.7 billion. Eliminating the loss of adherence (which occurred in one out of every four patients in our sample) would lead to another $3.6 billion in savings, for a combined potential savings of $8.3 billion. These benefits were particularly pronounced among poor and minority patients. Our analysis suggests that improved adherence among patients with diabetes should be a key goal for the health care system and policy makers. Strategies might include reducing copayments for certain medications or providing feedback about adherence to patients and providers through electronic health records.

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Section: Study Data and Methodsmentioning

confidence: 99%

Greater Adherence To Diabetes Drugs Is Linked To Less Hospital Use And Could Save Nearly $5 Billion Annually

Jha

Aubert²,

Yao³

et al. 2012

Health Affairs

146

112

View full text Add to dashboard Cite

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“…IMPACT OF MEDICATION ADHERENCE Across many chronic medical conditions, adherence has been associated with positive clinical outcomes including improved disease control, reduced symptoms, and decreased complications, hospitalization, and mortality [13][14][15][16][17][18][19][20]. Even modest nonadherence (e.g., 10-20 %) has been linked with clinically significant deteriorations in health outcomes, such as glycemic control, low-density lipoprotein cholesterol levels, and risk for coronary disease [21,22], as well as failure to achieve health improvements [23], leading to higher healthcare costs [21,24].…”

Section: Defining Medication Adherence Behaviormentioning

confidence: 99%

Self-report measures of medication adherence behavior: recommendations on optimal use

Stirratt

Dunbar‐Jacob

Crane

et al. 2015

Behav. Med. Pract. Policy Res.

597

528

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Medication adherence plays an important role in optimizing the outcomes of many treatment and preventive regimens in chronic illness. Self-report is the most common method for assessing adherence behavior in research and clinical care, but there are questions about its validity and precision. The NIH Adherence Network assembled a panel of adherence research experts working across various chronic illnesses to review selfreport medication adherence measures and research on their validity. Self-report medication adherence measures vary substantially in their question phrasing, recall periods, and response items. Self-reports tend to overestimate adherence behavior compared with other assessment methods and generally have high specificity but low sensitivity. Most evidence indicates that self-report adherence measures show moderate correspondence to other adherence measures and can significantly predict clinical outcomes. The quality of self-report adherence measures may be enhanced through efforts to use validated scales, assess the proper construct, improve estimation, facilitate recall, reduce social desirability bias, and employ technologic delivery. Self-report medication adherence measures can provide actionable information despite their limitations. They are preferred when speed, efficiency, and low-cost measures are required, as is often the case in clinical care. KeywordsAdherence, Compliance, Self-management, Medication, Self-report Valid measurement of medication adherence plays a crucial role in healthcare and health research. When a patient is not benefiting from a medication regimen, clinicians need sound adherence information to determine whether the medication is ineffective or not being taken as prescribed. Assessing medication adherence during routine clinical care can further ensure that individuals in need of adherence support interventions receive them, ideally before deleterious outcomes occur. In the context of clinical research, proper interpretation of proof-of-concept trials testing new pharmacologic regimens requires valid adherence data, because any null findings may stem from poor adherence rather than a lack of drug efficacy. Research designed to understand and promote medication adherence also requires precise methods of adherence assessment.Among many approaches to assessing medication adherence, patient self-report measures remain the most common method [1][2][3][4][5][6]. These measures are defined by asking respondents to characterize their medication adherence behavior. Self-report measures of medication adherence range from simple singleitem questions regarding missed doses to complex multi-item assessments that incorporate reasons for nonadherence [7]. The widespread use of self-report adherence measures in clinical care and research reflects their low cost and ease of implementation across a large variety of medication regimens.There are two primary challenges related to selfreport measures of medication adherence. ImplicationsPractice: Routine assessment of medication...

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“…4 It has been suggested that compliance with a specific recommendation might be a marker for compliance with other recommendations or lifestyle changes. 5 Unfortunately, direct comparisons of compliance with different recommendations in the same study population are not available. The present study aims to address this gap by examining long-term compliance with nonpharmacological recommendations and by assessing variables associated with long-term compliance.…”

mentioning

confidence: 99%

Long-Term Compliance With Nonpharmacologic Treatment of Patients With Heart Failure

Nieuwenhuis

Jaarsma

Veldhuisen

et al. 2012

The American Journal of Cardiology

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The aim of this study was to examine long-term compliance with non-pharmacological treatment of patients with heart failure (HF) and its associated variables. Data of 648 hospitalized HF patients (mean age 69±12 years; 38% female; mean left ventricular ejection fraction [LVEF] 33±14%) were analyzed. Compliance was assessed by means of self-report at baseline and 1, 6, 12, and 18 months after discharge. Patients completed questionnaires on depressive symptoms, HF knowledge, and physical functioning at baseline. Logistic regression analyses were performed to examine independent associations with low long-term compliance. From baseline to 18 months at follow-up, long-term compliance with diet and fluid restriction ranged from 77%-91% and 72%-89% respectively. In contrast, compliance with daily weighing (34%-85%) and exercise (48%-64%) was lower. Patients who were in New York Heart Association (OR 3.55,), and less physical functioning (OR 0.99, were associated with low compliance with exercise. In conclusion, long-term compliance with exercise and daily weighing was lower than long-term compliance with advice on diet and fluid restriction. Although knowledge on HF and being offered educational support positively affected compliance with weighing and fluid restriction, these variables were not related to compliance with exercise. Therefore, new approaches to help HF patients stay physically active are needed. Key-words:Adherence; Compliance; Heart Failure; Non-Pharmacological Treatment. 3Although it has been well established, most studies on determinants of compliance in patients with heart failure (HF) are cross-sectional, or focus solely on compliance with 1 specific non-pharmacological recommendation. Data on temporal trends in compliance with cardiovascular medication have been reported previously 1 , but little is known about long-term compliance with non-pharmacological treatment (i.e., sodium-restricted diet, fluid restriction, daily weighing, and exercise) and its determinants. Noncompliance with non-pharmacological treatment is related to adverse outcomes 2 and lower quality of life. 3 It is therefore vital to identify those patients who are at risk for noncompliance over a longer period of time, especially since studies have shown that noncompliance is a problem in the HF population. 4 It has been suggested that compliance with a specific recommendation might be a marker for compliance with other recommendations or lifestyle changes. 5 Unfortunately, direct comparisons of compliance with different recommendations in the same study population are not available. The present study aims to address this gap by examining long-term compliance with nonpharmacological recommendations and by assessing variables associated with long-term compliance. MethodsThe study employed a descriptive, prospective design and used data from the COACH (Coordinating study evaluating Outcomes of Advising and Counseling in Heart failure) study.COACH was a randomized, multi-center, controlled study in which 1023 HF patient...

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Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial

Cited by 419 publications

References 50 publications

Greater Adherence To Diabetes Drugs Is Linked To Less Hospital Use And Could Save Nearly $5 Billion Annually

Greater Adherence To Diabetes Drugs Is Linked To Less Hospital Use And Could Save Nearly $5 Billion Annually

Self-report measures of medication adherence behavior: recommendations on optimal use

Long-Term Compliance With Nonpharmacologic Treatment of Patients With Heart Failure

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