Medication Appropriateness and Medication Adherence of Heart Failure Patients: A Cross-sectional Observational Study

Abstract

Background: Heart failure is a global health burden with increasing prevalence and new incidences. It is a chronic cardiovascular disease that requires long-term treatment with appropriate medications. Hence, prescribing appropriate medications and the patient’s adherence to medications are essential in achieving optimum treatment outcomes among heart failure patients. Objectives: To assess the medication appropriateness, medication adherence and evaluate the influence of socio-demographic factors on medication adherence of heart failure patients Methods: This was a cross-sectional observational study conducted at the cardiovascular clinic of National Hospital Kandy. Patients diagnosed with heart failure, older than 18 years were recruited after obtaining informed written consent. Appropriateness of clinic medications was assessed using the Medication Appropriateness Index (MAI); higher MAI scores indicated low appropriateness. A detailed medication history was obtained from each participant for the medication adherence assessment using the Brief Medication Questionnaire (BMQ). Patients were classified into four adherence-related categories based on their scores for each screen in BMQ. Associations between medication adherence and socio-demographic factors were evaluated. Results: The total number of study participants was 325. The mean±SD MAI score was 0.56±0.25 (median:0.55, IQR:0.71-0.40). The mean±SD total BMQ score was 1.16±0.10 (median:1.00, IQR:1.70-0.43). Most of the patients were probable poor adherents (52.0%) followed by probable adherents (20.9%), poor adherents (15.4%) and the least complete adherents (11.7%). Statistically significant associations were observed between total BMQ score and age (p=0.039), gender (p=0.003) and education level (p=0.027). Conclusions: Appropriateness of prescribed medicines in the clinic was acceptable. However, medication adherence among heart failure patients was considerably poor whereas age, gender, and education level had influenced medication adherence. The importance of interventional studies to improve medication adherence in heart failure patients is apparent.