Adherence to Therapy in Polymorbid Patients with Chronic Heart Failure

Abstract

INTRODUCTION: Low adherence to doctors prescriptions turns into an increased risk of complications and high mortality for patients, and economic losses and deepening of negative demographic trends for the society. AIM: To study adherence to therapy in polymorbid patients with chronic heart failure (CHF). MATERIALS AND METHODS: The study included 313 patients hospitalized in the city center for treatment of chronic heart failure (CHF) in the period from February 1, 2019 to October 1, 2020 at the age of 75 ± 8.22 years. 66.77% Of patients were diagnosed with CHF with preserved left ventricular ejection fraction (EF), 19.81% — with intermediate, 13.42% — with low ejection fraction. Adherence to treatment was assessed by Morisky–Green questionnaire: 4 points — compliant patients, 2 and less points — non-compliant, 3 points — insufficiently compliant. RESULTS: In the groups, the majority of patients had arterial hypertension (AH) and coronary heart disease (CHD), 99.04% and 67.09%, respectively; 65.49% of patients had rhythm disorders in the form of atrial fibrillation or flutter (AFb/AFl); 20.45% of patients had chronic lung diseases, chronic obstructive pulmonary disease (COPD), 21.72% — malignant diseases, a third of patients (38.98%) — diabetes mellitus (DM), 14.69% — various joint diseases. Almost all patients (99.04%) with CHF were diagnosed with chronic kidney disease (CKD), 45.05% had anemia of different severity. The incidence of acute kidney injury (AKI) was higher in the group of compliant patients (30.59%, 35% and 44.72%; pmg = 0.046), mainly due to AKI diagnosed by the initial creatinine (pmg=0.038), predominantly of I stage (12.94%, 15% and 17.07%; pmg = 0.805). The groups were comparable in the frequency of AKI diagnosed in the hospital by the dynamics of creatinine (4.11%, 5% and 5.69%; pmg = 0.823). Patients did not differ in frequency until dialysis stages of chronic kidney disease (pmg = 0.763). CONCLUSION: Every third patient at the outpatient stage did not take drug therapy. Among non-compliant patients, there was a lower incidence of stable angina and joint diseases, a smaller number of patients with more than 5 diseases, they were more rarely hospitalized and more often had bad habits. On the contrary, in the group of compliant patients, there were more polymorbid patients with pain syndrome of different location, they were more often re-hospitalized.