Medication adherence and survival among hospitalized heart failure patients in a tertiary hospital in Tanzania: a prospective cohort study

Abstract

Objective: Management of heart failure is complex and multifaceted but adherence to medications remains the cornerstone of preventing avoidable readmissions, premature deaths, and unnecessary healthcare expenses. Despite of evidence-based efficacy on anti-failure drugs, poor adherence is pervasive and remains a significant barrier to improving clinical outcomes in heart failure population. Results:We enrolled 459 patients with diagnosis of heart failure admitted at a tertiary cardiovascular hospital in Dar es Salaam, Tanzania. The mean age was 46.4 years, there was a female predominance (56.5%), 67.5% resided in urban areas and 74.2% had primary education. Of the 419 participants eligible for assessment of medication adherence, 313 (74.7%) had poor adherence and 106 (25.3%) had good adherence. Possession of a health insurance was found to be the strongest associated factor for adherence (adjusted OR 8.7, 95% CI 4.7-16.0, p < 0.001). Participants with poor adherence displayed a 70% increased risk for rehospitalization compared to their counterparts with good adherence (adjusted RR 1.7, 95% CI 1.2-2.9, p = 0.04). Poor adherence was found to be the strongest predictor of early mortality (HR 2.5, 95% CI 1.3-4.6, p < 0.01). In conclusion, Poor medication adherence in patients with heart failure is associated with increased readmissions and mortality.

<p>Rheumatic Heart Disease Patients’ Adherence to Secondary Prophylaxis and Associated Factors at Hospitals in Jimma Zone, Southwest Ethiopia: A Multicenter Study</p>

“…The present finding was also consistent with other studies conducted in Africa: Uganda, 56 , 57 Malawi 58 , Tanzania, 59 and South Africa. 60 …”

“…The present finding was also consistent with other studies conducted in Africa: Uganda, 56,57 Malawi 58 , Tanzania, 59 and South Africa. 60 In this study, the commonest reasons reported for missing monthly benzathine prophylaxis injections was long distance from hospitals (56.9%), lack of money (38%), unaffordability (30.8%), and inconvenient work schedule (22.5%).…”

Using the Health Belief Model to Explain the Patient’s Compliance to Anti-hypertensive Treatment in Three District Hospitals - Dar Es Salaam, Tanzania: A Cross Section Study

“…Our study considered hypertensive patients with no other complications while the study conducted by Pallangyo et al involved admitted patients with heart failure as a complication of uncontrolled hypertension. 21 The current study shows that; participants who were 64 and below years of age had higher level of treatment compliance compared to those with 65 and above. The results are comparable to those reported in the study conducted by Demoner et al in the city of Maringá and Choi et al in Korea which reported that young age group showed association with treatment compliance and older frustrated and , hence, stop taking drugs.…”

“…19,20 Our findings showed that compliance to antihypertensive was higher than that of the study conducted by Pallangyo et al in tertiary hospitals in Tanzania which reported that 25.3% were compliant to their hypertensive treatment. 21 Study conducted by Bovet et al in Temeke Dar es Salaam, reported low (34%) adherence of patients to antihypertensive treatment. 17 Similar to a study by Goweda and Shatla.…”

“…Our study considered hypertensive patients with no other complications while the study conducted by Pallangyo et al involved admitted patients with heart failure as a complication of uncontrolled hypertension. 21 .…”