OBJECTIVE
To determine medication use and adherence among community-dwelling patients with heart
failure (HF).
PATIENTS AND METHODS
Residents of Olmsted County, Minnesota, with HF were recruited from October 10, 2007,
through February 25, 2009. Pharmacy records were obtained for the 6 months after enrollment.
Medication adherence was measured by the proportion of days covered (PDC). A PDC of
less than 80% was classified as poor adherence. Factors associated with medication
adherence were investigated.
RESULTS
Among the 209 study patients with HF, 123 (59%) were male, and the mean ± SD age was
73.7±13.5 years. The median (interquartile range) number of unique medications filled
during the 6-month study period was 11 (8-17). Patients with a documented medication
allergy were excluded from eligibility for medication use within that medication class.
Most patients received conventional HF therapy: 70% (147/209) were treated with β-blockers
and 75% (149/200) with angiotensin-converting enzyme inhibitors or angiotensin II
receptor blockers. Most patients (62%; 127/205) also took statins. After exclusion
of patients with missing dosage information, the proportion of those with poor adherence
was 19% (27/140), 19% (28/144), and 13% (16/121) for β-blockers, angiotensin-converting
enzyme inhibitors or angiotensin II receptor blockers, and statins, respectively.
Self-reported data indicated that those with poor adherence experienced more cost-related
medication issues. For example, those who adhered poorly to statin therapy more frequently
reported stopping a prescription because of cost than those with good adherence (46%
vs 6%; P<.001), skipping doses to save money (23% vs 3%; P=.03), and not filling a new prescription because of cost (46% vs 6%; P<.001).
CONCLUSION
Community-dwelling patients with HF take a large number of medications. Medication
adherence was suboptimal in many patients, often because of cost.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Mayo Clinic ProceedingsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
REFERENCES
- Heart disease and stroke statistics–2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee [published corrections appear in Circulation. 2010;122 (1):ell and 2009;119(3):e182].Circulation. 2009; 119: e21-e181
- ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure).Circulation. 2005; 112: e154-e235
- Pharmacist intervention to improve medication adherence in heart failure: a randomized trial.Ann Intern Med. 2007; 146: 714-725
- Objectively measured, but not self-reported, medication adherence independently predicts event-free survival in patients with heart failure.J Card Fail. 2008; 14: 203-210
- Utilization of, and adherence to, drug therapy among medicaid beneficiaries with congestive heart failure.Clin Ther. 2007; 29: 1771-1783
- Predictors of refill non-adherence in patients with heart failure.Br J Clin Pharmacol. 2007; 63: 488-493
- Adherence in heart failure in the elderly: problem and possible solutions.Int J Cardiol. 2008; 125: 203-208
- Nurse evaluation of patients in a new multidisciplinary Heart Failure Unit in Spain.Eur J Cardiovasc Nurs. 2004; 3: 61-69
- Noncompliance with congestive heart failure therapy in the elderly.Arch Intern Med. 1994; 154: 433-437
- Pilot study of a Web-based compliance monitoring device for patients with congestive heart failure.Heart Lung. 2003; 32: 226-233
- Congestive heart failure in the United States: is there more than meets the I(CD code)? The Corpus Christi Heart Project.Arch Intern Med. 2000; 160: 197-202
- The concordance of self-report with other measures of medication adherence: a summary of the literature.Med Care. 2004; 42: 649-652
- State and County QuickFacts: Olmsted County Minnesota.(Accessed February 17, 2011.)
- History of the Rochester Epidemiology Project.Mayo Clin Proc. 1996; 71: 266-274
- Prospective recruitment of patients with congestive heart failure using an ad-hoc binary classifier.J Biomed Inform. 2005; 38: 145-153
- The epidemiology of heart failure: the Framingham Study.J Am Coll Cardiol. 1993; 22(4): 6A-13A
- Measurement of adherence in pharmacy administrative databases: a proposal for standard definitions and preferred measures.Ann PharmacoTher. 2006; 40: 1280-1288
- Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: double-blind, randomised, controlled clinical trial.Lancet. 2005; 366: 2005-2011
- Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction.JAMA. 2007; 297: 177-186
- Defining an evidence-based cut-point for medication adherence in heart failure.Am Heart J. 2009; 157: 285-291
- Medication adherence in patients who have heart failure: a review of the literature.Nurs Clin North Am. 2008; 43: 133-153
- Medication adherence in cardiovascular disease.Circulation. 2010; 30; 121: 1455-1458
- Medication adherence: its importance in cardiovascular outcomes.Circulation. 2009; 119: 3028-3035
- Can simple clinical measurements detect patient noncompliance?.Hypertension. 1980; 2: 757-764
- The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report.JAMA. 2003; 289: 2560-2572
- Third Report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III) final report.Circulation. 2002; 106: 3143-3421
- Standards of medical care in diabetes–2006 [published correction appears in Diabetes Care. 2006;29(5):1192].Diabetes Care. 2006; 29: S4-S42
- Prediction of creatinine clearance from serum creatinine.Nephron. 1976; 16: 31-41
- Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology.J Am Soc Echocardiogr. 2005; 18: 1440-1463
- Trends in prevalence and outcome of heart failure with preserved ejection fraction.N Engl J Med. 2006; 355: 251-259
- Factors influencing medication adherence in patients with heart failure.Heart Lung. 2008; 37: 8-16
- Evaluation of the management of heart failure in primary care.Fam Pract. 2009; 26: 145-153
- Heart failure with preserved ejection fraction: treat now by treating comorbidities.JAMA. 2008; 300: 431-433
- Relationship between psychosocial variables and compliance in patients with heart failure.Heart Lung. 2001; 30: 294-301
- Methods for measuring and monitoring medication regimen adherence in clinical trials and clinical practice.Clin Ther. 1999; 21: 1074-1090
- Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure.Am Heart J. 2005; 150: 982
- Drug copayment and adherence in chronic heart failure: effect on cost and outcomes.Pharmacotherapy. 2006; 26: 1157-1164
- Impact of a prescription copayment increase on lipid-lowering medication adherence in veterans.Circulation. 2009; 119: 390-397
- Medicare Part D-a roundtable discussion of current issues and trends.J Manag Care Pharm. 2009; 15(1): 3-9
- Supplemental insurance and use of effective cardiovascular drugs among elderly Medicare beneficiaries with coronary heart disease.JAMA. 2001; 286: 1732-1739
- Validity of a prescription claims database to estimate medication adherence in older persons.Med Care. 2006; 44: 471-477
Article Info
Footnotes
This study was supported by grants from the National Institutes of Health ( RO1HL72435, T32 HL07111-31A1 ) and was made possible by the Rochester Epidemiology Project ( AG034676 , National Institute on Aging).
An earlier version of this article appeared Online First.
Identification
Copyright
© 2011 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Medication Adherence: Hope for Improvement?Mayo Clinic ProceedingsVol. 86Issue 4
- PreviewIn this issue of Mayo Clinic Proceedings, 2 important articles underscore the magnitude of the problem of medication nonadherence, one in the context of cardiovascular disease1 and one more generally,2 but also offer suggestions for improvement. The original research article by Dunlay et al1 investigated the proportion of patients prescribed drugs for heart failure who did not adhere to the medication regimen and the factors underlying their poor adherence. Brown and Bussel2 performed a systematic review of the literature to examine the origins of, and solutions to, poor medication adherence and explored the efforts of organizations such as the World Health Organization to address existing deficiencies.
- Full-Text
- Preview
