Interv Akut Kardiol. 2019;18(3):127-132 | DOI: 10.36290/kar.2019.033

How to recognize a non-adherent chronic heart failure patient?

Radek Pelouch^1,2, Viktor Voříšek³, Věra Furmanová³, Miroslav Solař^1,2

¹ Katedra interních oborů, Lékařská fakulta v Hradci Králové, Karlova Univerzita v Praze, Hradec Králové

² I. interní kardioangiologická klinika, Fakultní nemocnice Hradec Králové

³ Ústav klinické biochemie a diagnostiky, Fakultní nemocnice Hradec Králové

Objective: To evaluate drug non-adherence (NA) in chronic heart failure (CHF) patients based on routine examinations.

Methods: Routine examination results, patient questionnaires as well as adherence (A) assessment by both the patient and physician were analyzed. Serum drug levels (SDLs) were used as a reference method.

Results: Eighty-one patients were enrolled. Using SDL, non-adherence was shown in 25 %. All patients reported to have taken their drugs properly. Omission of a dose a week was admitted by 18 % of A and 25 % of NA patients (p = 0.53). The physician correctly assumed NA in 40 % of NA patients, but incorrectly in 10 % of A. There was a trend among women to be more non-adherent (p = 0.055) while in patients from a village or small town lower NA (p = 0.031) was observed. The systolic (137 ± 13 vs. 124 ± 15 mm Hg, p = 0.001) and diastolic (83 ± 11 vs. 75 ± 9 mm Hg, p = 0.002) blood pressure values were higher in NA. There was a trend towards a higher heart rate (83 ± 18 vs. 73 ± 13, p = 0.052) in NA, with a significant difference in patients treated with beta-blockers (94 ± 19 vs. 73 ± 12, p < 0.001). Adherent patients rated their health status better (p = 0.052). No differences were found in the other parameters.

Conclusion: NA may be predicted in persistent high blood pressure and in high heart rate despite beta-blockers. NA can be confirmed by SDL assessment.

Keywords: chronic heart failure, drug non-adherence, pharmacotherapy, serum drug levels

Published: November 1, 2019  Show citation