What puts heart failure patients at risk for poor medication adherence?

Abstract

BackgroundMedication nonadherence is a major cause of hospitalization in patients with heart failure (HF), which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization.Materials and methodsMedication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS). A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%). Participants were primarily white (68.3%), male (64.2%), and retired (44.5%). Education ranged from 8–29 years (mean, 14.0 years; standard deviation, 2.9 years). Ages ranged from 30–89 years (mean, 62.8 years; standard deviation, 11.6 years). Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them.ResultsA total of 63 (28.9%) patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer global sleep quality. Patients had between zero and three risk factors. The odds for poor adherence increased by 2.6 times with a unit increase in the number of risk factors (odds ratio, 2.62; 95% confidence interval, 1.78–3.86; P<0.001).ConclusionNewly diagnosed, older HF patients with comorbid conditions, polypharmacy, and poor sleep are at risk for poor medication adherence. Interventions addressing these specific barriers are needed.

Dietary Patterns, Nutrition Knowledge, Lifestyle, and Health-Related Quality of Life: Associations with Anti-Hypertension Medication Adherence in a Sample of Australian Adults

“…However, individuals with good adherence had more hours sleep per night (average of 7 hours) compared to those from the poor adherence group (6 hours). Although the focus of this variable was on the quantity of sleep rather than quality, medication adherence can decrease with a reduction in sleep quality [43]. Perhaps inadequate and poor quality sleep can influence cognitive function [43], and the ability to pay attention and make good decisions [44].…”

“…Although the focus of this variable was on the quantity of sleep rather than quality, medication adherence can decrease with a reduction in sleep quality [43]. Perhaps inadequate and poor quality sleep can influence cognitive function [43], and the ability to pay attention and make good decisions [44]. Impaired cognitive function may increase forgetfulness and unintentional medication non-adherence.…”

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

“…3) The adaptive multiple risk factors model was used to generate the associated risk index model for medication nonadherence, based on the count of that model’s risk factors. Interactions between risk factors were not considered in these subgroup analyses (as they were in analyses of the full data; Knafl & Riegel, 2014) because meaningful interaction results were unlikely given the modest subgroup sample sizes.…”

“…In the first two analyses, we used the World Health Organization dimensions of adherence (socioeconomic, condition, therapy, patient, and healthcare system) to focus our exploration of contributors to nonadherence (Riegel & Knafl, 2013; Riegel et al, 2012). In the third analysis, we tested a wide range of clinical and patient-related variables (demographic, social support, self-care, symptoms, and cognition) to avoid omitted variable bias (Knafl & Riegel, 2014). In a subsequent study we found that Blacks had poorer medication adherence than Whites (Dickson, Knafl, & Riegel, 2015).…”

Cumulative Cardiovascular Polypharmacy Is Associated With the Risk of Acute Kidney Injury in Elderly Patients

“…Moreover, as more medications are used adherence and compliance to treatments often decrease and drug interactions and adverse effects become more common. 2 , 3 Prescription of complex regimens and the resultant nonadherence may potentially contribute to poor disease control, recurrent hospitalizations, and higher mortality. 4 , 5 Thus, polypharmacy is an issue of critical importance for geriatric patients and their prescribers.…”