Why the study?
Existing studies on adherence had not directly measured levels of all prescribed medications or their metabolites in patients with heart failure.
Objective assessment using urine mass spectrometry revealed that nearly 1 in 5 patients with heart failure are non-adherent to prescribed medications 4-6 weeks after hospitalization.
Answers are grounded in this paper and cite their sources.
Non-adherence affects ~18% of post-HF hospitalization patients; hypothesis-generating for targeted interventions before practice change.
AIMS: None of the existing studies on adherence have directly measured levels of all medications (or their metabolites) in patients with heart failure (HF). METHODS AND RESULTS: We used liquid chromatography-tandem mass spectrometry to measure the presence of prescribed drugs (diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists) in the urine of patients reviewed 4-6 weeks after hospitalization with HF. Patients were unaware that adherence was being assessed. Of the 341 patients studied, 281 (82.4%) were adherent, i.e. had all prescribed drugs of interest detectable in their urine. Conversely, 60 patients (17.6%) were partially or completely non-adherent. Notably, 24 of the 60 were non-adherent to only diuretic therapy and only seven out of all 341 patients studied (2.1%) were completely non-adherent to all prescribed HF drugs. There were no major differences in baseline characteristics between adherent and non-adherent patients. CONCLUSION: Non-adherence, assessed using a single spot urine measurement of drug levels, was confirmed in one of five patients evaluated 4-6 weeks after hospitalization with HF.
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Simpson et al. (2020) studied this question.
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