Patient-reported outcomes and medication adherence in patients with heart failure

Abstract

Aim Patient-reported outcome measures (PROMs) may predict poor clinical outcome in patients with heart failure (HF). It remains unclear whether PROMs are associated with subsequent adherence to HF medication. We aimed to determine whether health-related quality of life, anxiety and depression were associated with long-term medication adherence in these patients. Methods and results A national cohort study of Danish patients with HF with three-year follow-up (n = 1,464). PROMs included the EuroQol five-dimensional, five-level questionnaire (EQ-5D-5L), the HeartQoL and the Hospital Anxiety and Depression Scale (HADS). Patient-reported outcomes (PRO) data were linked to demographic and clinical data at baseline, and data on all redeemed prescriptions for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors (ACEI/ARB/ARNI), β-blockers and mineralocorticoid receptor antagonists (MRAs) during follow-up. Medication non-adherence was defined as < 80% of proportion of days covered (PDC). In adjusted regression analyses, lower health-related quality of life (EQ-5D and HeartQoL) and symptoms of depression (HADS-D) at discharge were associated with non-adherence. After three years of follow-up, lower health-related quality of life (EQ-5D) was associated with non-adherence for ACEI/ARB/ARNI (adjusted OR 2.78, 95% CI:1.19-6.49), β-blockers (adjusted OR 2.35, 95% CI:1.04-5.29), whereas HADS-D was associated with non-adherence for ACEI/ARB/ARNI (adjusted OR 1.07, 95% CI:1.03-1.11) and β-blockers (adjusted OR 1.06, 95% CI:1.02-1.10). Conclusion Lower health-related quality of life and symptoms of depression were associated with non-adherence across HF medications at one- and three years of follow-up. Person-centred care using PROMs may carry a potential for identifying patients at increased risk of future medication non-adherence.

Physician adherence and patient-reported outcomes in heart failure with reduced ejection fraction in the era of angiotensin receptor-neprilysin inhibitor therapy

“…Data from these HF registries 17 – 21 revealed a lower prescription rate for all 3 categories of medications. However, recent prospective HFrEF trials showed a higher prescription rate for these medications 15 . In the present study, the use of renin-angiotensin system blockers was 91.5%, which included ARNIs (32.4%).…”

“…PROs enable physicians to deliver more patient-centered care, thereby improving patients’ quality of life. A recent study showed that nonadherence to medication also correlated with poor PROs 15 . Real-world nationwide data on adherence to guideline-recommended treatment and PROs in Asian patients with HF are lacking with respect to ARNIs.…”

Long-term Effects of Perceived Stress, Anxiety, and Anger on Hospitalizations or Death and Health Status in Heart Failure Patients

“…Thus, mechanism(s) accounting for hospitalizations may not be specific to HF, but may also affect comorbidities. Potentially preventable nonspecific mechanisms could involve systemic responses such as inflammation, systemic stress responses, and increased symptom perception, poor adherence to diet or medications, or depression (13, 20, 40, 43).…”

Treatment of Heart Failure Patients with Anxiolytics Is Associated with Adverse Outcomes, with and without Depression

“…Clinically anxious individuals have also been found to have higher levels of IL-6 [35] and lower levels of morning cortisol, even in the absence of depression [35]. Anxiety is associated with lesser performance of physical activity and lower educational levels, but unlike depression, has not been associated with decreased adherence to pharmacologic treatment [36], although anxious patients are less likely to be adherent to cardiac rehabilitation programs [37]. Anxiety is also associated with sleep disturbance, which may itself present a risk factor for poor outcomes in HF.…”