Predictors of Objectively Measured Medication Nonadherence in Adults With Heart Failure

Abstract

Background Medication nonadherence rates are high. The factors predicting nonadherence in heart failure (HF) remain unclear. Methods and Results A sample of 202 adults with HF was enrolled from the Northeastern U.S. and followed for 6 months. Specific aims were to describe the types of objectively measured medication nonadherence (e.g. taking, timing, dosing, drug holidays) and to identify contributors to nonadherence 6 months after enrollment. Latent growth mixture modeling (GMM) was used to identify distinct trajectories of adherence. Indicators of the five World Health Organization (WHO) dimensions of adherence (socioeconomic, condition, therapy, patient, and health care system) were tested to identify contributors to nonadherence. Two distinct trajectories were identified and labeled persistent adherence (77.8%) and steep decline (22.3%). Three contributors to the steep decline in adherence were identified. Participants with lapses in attention (adjusted odds ratio (OR) = 2.65, p=0.023), those with excessive daytime sleepiness (OR = 2.51, p=0.037), and those with two or more medication dosings per day (OR = 2.59, p=0.016) were more likely to have a steep decline in adherence over time than to have persistent adherence. Conclusions Two distinct patterns of adherence were identified. Three potentially modifiable contributors to nonadherence have been identified.

The Pharmacist Role in Predicting and Improving Medication Adherence in Heart Failure Patients

“…6,8,10,12,[21][22][23][24][25][26][27][28][29][30][31][32] Table 1 may assist the health care provider in recognizing predictors that may impact adherence to HF medications. Table 2 depicts a summary of the studies identifying predictors of decreased 6,8,10,[21][22][23][24][25][26]28,29,32 and increased 8,12,22,[26][27][28]30,31 HF medication adherence. Large, observational cohort studies extracting adherence and demographic data from health insurance claims databases or HF registries with 2 to 4 years of follow-up data from the United States found some similar significant predictors for nonadherence, including male gender or nonwhite race.…”

“…Wu et al (2012) conducted a series of studies in HF patients to determine factors affecting event-free survival, factors defined as ED visits for symptoms of decompensated HF, HF or cardiac hospitalizations, and all-cause mortality. 31 The studies found that those who were not married (P = 0.044), 31 Lapses in attention 24 Excessive daytime sleepiness with or without mild cognitive decline 24,25 Advanced age (≥ 65 years) 29 …”

“…Increased frequency of HF medication dosing (at least twice daily) 10,24 Patient-reported changes to daily routine to accommodate HF medication schedule 10 Antiarrhythmic use 27 Prior use of same class of HF medication 23,27,29 Concurrent use of cardiac medications 29 Concomitant medications 27 Patient knowledge of correct dosing times 8 …”

Comparison of self-care behaviors of heart failure patients in 15 countries worldwide

“…Although the reported data on self-care in medication taking are high, education and support to appropriately use medication is still needed. In many populations older adults often use nonprescription and inappropriate drugs or forget to take their medication [26][27][28][29]. Patients may use herbal medication or traditional medication in addition to prescribed pharmacotherapy and may not be aware of drug interactions [30].…”

Improving medication adherence of patients with chronic heart failure: challenges and solutions

“…36 As the number of pills taken per day is increased, medication adherence increases. 41,42 Also, patients are more likely to skip a dose when they experience side effects. 41,42 Patient-related factors that affect medication adherence include forgetting, feeling that treatment has "succeeded" as evidenced by decreased or absent symptoms, excessive daytime sleepiness, poor attention span, and cognitive decline.…”