Predictors of medication nonadherence differ among black and white patients with heart failure

Abstract

Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF.

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

“…In this present study, nearly 60% of participants with poor adherence were rehospitalized within 6-months of enrollment. Our findings are in consonance with several other prospective studies which have produced rehospitalization rates ranging between 20 and 69% [16,32,33,38,39]. Additionally, intervention studies have uniformly shown that improved adherence is associated with reduction (3-96%) in readmission risk [40,41,43,44,[46][47][48][49].…”

“…With regards to reasons for poor adherence, numerous factors have predominated in various studies. [29,32]. In this present study, nearly 90% of nonadherent participants reported medication cost as the major barrier to their adherence.…”

“…Despite of unwavering evidence on the efficacy of antifailure drugs, poor adherence is common and remains a significant barrier to improving clinical outcomes in heart failure population. Estimates of nonadherence in heart failure patients have varied widely (22-90%) [18,25,[29][30][31][32][33][34][35][36] in the literature. In this present study, less than one-fifth of participants were categorized as having high adherence.…”

“…It should not be forgotten that such poor societies and their already overwhelmed health sectors continue to struggle with prevention and management of the ever present infectious diseases. Several studies have demonstrated the repercussions of poor adherence on prognosis of heart failure [16,32,33,38,39]. Moreover, numerous studies have established the prognostic benefits of interventions to improve adherence [24,[40][41][42][43][44][45][46][47][48][49][50].…”

In South Asian people with cardiac disease, strong patient–professional relationships may increase treatment compliance

“…Submitted for publication, 2015). Another study reported that African-American heart failure patients had more and different risk factors (more comorbidity, lower serum sodium, higher systolic blood pressure and fewer methods of compensating for forgetfulness) for medication adherence than Caucasians 1. More studies exploring how race and ethnicity influence behaviour are greatly needed.…”