Predictors and impact of medication non-adherence in heart failure patients: a retrospective cohort from a tertiary hospital in Yemen.

Q: What are the key findings of this study?

Clinician-documented medication non-adherence in heart failure patients was associated with a six-fold increased risk of hospital readmission (RR 6.0) within 180 days.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Heart failure (n=162). Intervention: Clinician-documented medication non-adherence vs. Adherent patients. Primary outcome: Hospital readmission within 180 days (RR 6.0, 95% CI 3.5-10.2, p=<0.001).

Q: What question did this study set out to answer?

Identify independent predictors of clinician-documented medication non-adherence and measure its impact on six-month readmission and mortality among patients hospitalized with heart failure.

Safwana Al-Tahesh; Basheera Abdo; Mamoona Al-Namer; Fadhla Alselmi; Mohammed Abdo Abdullah; Faisal Ahmed

doi:10.11604/pamj.2026.53.9.48712

January 1, 2026Open Access

Predictors and impact of medication non-adherence in heart failure patients: a retrospective cohort from a tertiary hospital in Yemen.

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Key result

Medication non-adherence in heart failure linked to a ~6-fold higher risk of 180-day readmission.

RR 6.0
95% CI 3.5-10.2
P<0.001
NNT 2.1
n=162

Figures

Why the study?

Does medication non-adherence increase the risk of hospital readmission and all-cause mortality in heart failure patients?

Key Points

Identify independent predictors of clinician-documented medication non-adherence and measure its impact on six-month readmission and mortality among patients hospitalized with heart failure.
Retrospective single-centre cohort study evaluating 162 heart failure patients meeting inclusion criteria at Al-Thawra General Hospital over a six-month follow-up period.
Collected demographic, behavioral, and clinical variables to perform univariate and multivariable logistic regression analyses identifying independent risk factors for clinician-documented medication non-adherence.
Compared six-month hospital readmission and all-cause mortality rates between adherent and non-adherent patient cohorts using relative risk and Kaplan-Meier survival curves.
Clinician-documented medication non-adherence was present in 39.5% (n=64) of patients and was independently predicted by increasing age (aOR 1.15 per year; 95% CI 1.09-1.22; p<0.001), male gender (aOR 4.1; 95% CI 1.1-15.2; p=0.017), smoking (aOR 12.4; 95% CI 3.3-47.4; p=0.015), khat chewing (aOR 2.95; 95% CI 1.21-7.19; p=0.018), and chronic kidney disease (aOR 4.12; 95% CI 1.02-16.67; p=0.047).
Non-adherent patients experienced a markedly higher rate of hospital readmission than adherent patients (79.7% vs. 13.3%; RR 6.0; 95% CI 3.5-10.2; p<0.001; NNH 2.1).
Six-month all-cause mortality was significantly elevated in non-adherent patients compared with adherent patients (25.0% vs. 6.1%; RR 4.1; 95% CI 1.7-9.8; p=0.001; NNH 5.3).

Study Design

Type

Cohort (n=162)

Multicenter

No

Structured PICO

Does medication non-adherence increase the risk of hospital readmission and all-cause mortality in heart failure patients?

P

Population

162 adult patients with heart failure at a tertiary center in Yemen, followed for 180 days to assess the impact of medication non-adherence.

E

Exposure

Clinician-documented medication non-adherence (assessed based on explicit notes in clinical records indicating missed doses, irregular intake, or self-discontinuation of prescribed heart failure therapies)

C

Comparator

Clinician-documented medication adherence (records indicating consistent medication use)

O

Outcome

Hospital readmission (any unplanned admission for any cause) and all-cause mortality within 180 days of the index discharge or HF diagnosishard clinical

Main Result

Relative Risk: 6 (95% CI 3.5–10.2)

Absolute Event Rate: 79.7% vs 14.1%

Number Needed to Treat: 2.1

p-value: p=<0.001

Limitations

Reliance on subjective clinician-documented adherence, which is prone to bias and likely underestimates true non-adherence
Single-centre study limits generalizability
Retrospective design restricts causal inference
Exclusion of records with missing data without imputation introduces potential selection bias
Did not capture key variables such as socioeconomic status, health literacy, or detailed medication regimens
Relatively short six-month follow-up period
Reliance on clinician-documented adherence is subjective, prone to bias, and likely underestimates the true non-adherence rate
Single-centre design limits generalizability to other regions or healthcare settings
Short six-month follow-up period
May have missed readmissions or deaths occurring outside the study hospital

Implication

Medication non-adherence is highly prevalent among heart failure patients in Yemen and is strongly associated with increased 6-month readmission and mortality, highlighting the need for targeted interventions addressing local behavioral factors like khat chewing.

Abstract

in this single-centre Yemeni cohort, clinician-documented non-adherence was prevalent and strongly predicted by specific demographic, behavioral, and clinical factors. The independent predictors of non-adherence in this setting include advanced age, male gender, smoking, khat chewing, and chronic kidney disease. Non-adherence was associated with a dramatically increased risk of readmission and death. These findings highlight the urgent need for targeted interventions addressing modifiable risks like smoking and khat use to improve outcomes in this and similar settings.

Discussion

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Cite This Study

Al-Tahesh et al. (2026) conducted a cohort in Heart failure (n=162). Clinician-documented medication non-adherence vs. Adherent patients was evaluated on Hospital readmission within 180 days (RR 6.0, 95% CI 3.5-10.2, p=<0.001). Clinician-documented medication non-adherence in heart failure patients was associated with a six-fold increased risk of hospital readmission (RR 6.0) within 180 days.

synapsesocial.com/papers/69d5efd374eaea4b11a79647 https://doi.org/10.11604/pamj.2026.53.9.48712

Topics

Heart failure

HFrEF treatment

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Predictors and impact of medication non-adherence in heart failure patients: a retrospective cohort from a tertiary hospital in Yemen.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Predictors and impact of medication non-adherence in heart failure patients: a retrospective cohort from a tertiary hospital in Yemen.

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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