Objective assessment of medication adherence in patients with acutely decompensated heart failure revealed that only 39% were fully adherent, while 22% were non-adherent to ≥2 prescribed drugs.
Cross-Sectional (n=100)
What is the true rate of medication adherence in patients presenting to the emergency department with acutely decompensated heart failure?
Objective assessment via urine toxicology reveals that only 39% of patients presenting with acutely decompensated heart failure are fully adherent to their prescribed medications, highlighting non-adherence as a major contributor to decompensation.
Abstract Aim Non-adherence to guideline-directed medical therapy may cause worsening of chronic heart failure (CHF). However, objectively assessed adherence in patients presenting with acutely decompensated heart failure (ADHF) remains largely unexplored. This study aimed to evaluate adherence to medication in patients with ADHF presenting to the emergency department. Methods and results This cross-sectional study assessed medication adherence using both indirect (self-reported) and direct methods (qualitative toxicological analysis in urine). A total of 100 patients were included, of whom 61% were men, with a mean age of 77.9±10.1 years, and a median NT-proBNP level of 4,846 pg/mL (interquartile range 2,091–9,863). Of these, 35% had reduced left ventricular ejection fraction (LVEF ≤40%), 22% mildly reduced LVEF (41–49%), and 43% preserved LVEF (≥50%). In 39% of patients, all prescribed CHF medications were detected in urine, indicating full adherence. Partial adherence was observed in 39% of patients, with 1 prescribed CHF medication not detected. Non-adherence, defined as the absence of ≥2 prescribed CHF drugs, was observed in 22% of patients. Non-adherent patients had a significantly higher number of CHF medications prescribed compared with partially adherent (p=0.0047) and adherent (p=0.0002) patients and had a significantly higher pill burden than adherent patients (p=0.002). Non-adherent patients were younger than partially adherent (p=0.0144) and adherent (p=0.0054) patients. Adherent patients were significantly more likely to have an abnormal DemTect cognitive screening test result (p=0.049). Medication prepared by a third party, such as caregiver or a pharmacist, reduced the likelihood of both non-adherence and partial adherence. Self-reported adherence monitoring was found to be inaccurate. Conclusions Adherence to CHF medication in patients presenting with ADHF was low, with only 39% of patients fully adherent. Non-adherence to medical therapy represents a significant but often overlooked contributor to worsening CHF, potentially leading to ADHF hospitalization.Graphical Abstract Figure 2
Kunz et al. (Sat,) conducted a cross-sectional in Acutely decompensated heart failure (ADHF) (n=100). Medication adherence assessment (urine toxicology and self-report) was evaluated on Full medication adherence (all prescribed CHF medications detected in urine). Objective assessment of medication adherence in patients with acutely decompensated heart failure revealed that only 39% were fully adherent, while 22% were non-adherent to ≥2 prescribed drugs.