Abstract
Pedro Pallangyo
Abstract
Background: 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. Methods: We enrolled 459 patients with established diagnosis of heart failure. Sociodemographic, clinical, laboratory, and echocardiographic data were gathered using a structured questionnaire during the hospital admission of enrollment. Medication adherence was assessed using the 8-item Morisky Medication Adherence Scale (MMAS-8). The primary outcome measures were rehospitalization and mortality at 180-days. Linear logistic regression analyses were used to assess for factors associated with adherence and predictors of rehospitalization. Based on their adherence status, participants were compared with respect to survival using Cox proportional-hazards regression model. All tests were 2-sided and p<0.05 was used to denote statistical significance. Results: The mean age was 46.4 years and participants aged ≤50 years constituted 55.4% of the cohort. There was a female predominance (56.5%), 67.5% resided in urban areas and 74.2% had primary education. About 22% of all participants had health insurance. 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 (OR 8.7, 95% CI 4.7-16.0, P <0.001). During follow-up, rehospitalization rates were 32.8%, 48.1% and 53.0% at 30, 90 and 180 days respectively. Participants with poor adherence displayed a 70% increased risk for rehospitalization compared to their counterparts with good adherence (RR 1.7, 95% CI 1.2-2.9, p = 0.04). Overall, 177 (42.2%) patients survived the 180-days of follow-up. Poor adherence was found to be the strongest predictor of early mortality (HR 2.5, 95% CI 1.3-4.6, p<0.01). Conclusion: Poor medication adherence in patients with heart failure is associated with increased readmissions and mortality. In view of this, deliberate efforts to assess and improve adherence should be incorporated and become an integral part of daily patient management. Furthermore, strategies to increase health insurance acquisition are fundamental to improve adherence especially among persons living in resource-poor settings.