May 31, 2012Open Access
View Full PaperPredictors of Objectively Measured Medication Nonadherence in Adults With Heart Failure
Key Result
Lapses in attention (OR 2.65; P=0.023), excessive daytime sleepiness (OR 2.51; P=0.037), and ≥2 medication dosings per day (OR 2.59; P=0.016) predicted a steep decline in medication adherence.
Study Design
Type
Cohort (n=202)
Structured PICO
P
Population
202 adults with heart failure from the northeastern United States, followed for 6 months.
O
Outcome
Objectively measured medication adherence trajectories and contributors to nonadherence at 6 months
Lapses in attention, excessive daytime sleepiness, and multiple daily medication dosings are significant, potentially modifiable predictors of steep declines in medication adherence among heart failure patients.
Main Result
Odds Ratio: 2.65
p-value: p=0.023
Abstract
BACKGROUND: Medication nonadherence rates are high. The factors predicting nonadherence in heart failure remain unclear. METHODS AND RESULTS: A sample of 202 adults with heart failure was enrolled from the northeastern United States and followed for 6 months. Specific aims were to describe the types of objectively measured medication adherence (eg, taking, timing, dosing, drug holidays) and to identify contributors to nonadherence 6 months after enrollment. Latent growth mixture modeling was used to identify distinct trajectories of adherence. Indicators of the 5 World Health Organization dimensions of adherence (socioeconomic, condition, therapy, patient, and healthcare system) were tested to identify contributors to nonadherence. Two distinct trajectories were identified and labeled persistent adherence (77.8%) and steep decline (22.3%). Three contributors to the steep decline in adherence were identified. Participants with lapses in attention (adjusted OR, 2.65; P=0.023), those with excessive daytime sleepiness (OR, 2.51; P=0.037), and those with ≥2 medication dosings per day (OR, 2.59; P=0.016) were more likely to have a steep decline in adherence over time than to have persistent adherence. CONCLUSIONS: Two distinct patterns of adherence were identified. Three potentially modifiable contributors to nonadherence have been identified.