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Directly Measured Adherence to Treatment in Chronic Heart Failure: LEVEL-CHF Registry
Libor Jelínek1, Jan Václavík2, Zdeněk Ramík3
11st Department of Internal Medicine - Cardiology, Faculty of Medicine and Dentistry, Olomouc University Hospital, Palacky University, Olomouc, Czech Republic.
Insights
Directly measuring medication adherence in chronic heart failure patients using serum drug levels revealed significant non-adherence, particularly in younger individuals. This highlights the need for improved monitoring strategies in heart failure management.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Current data on heart failure medication adherence relies heavily on indirect methods.
- Direct assessment using serum drug levels offers a more accurate measure of patient adherence.
Purpose of the Study:
- To evaluate medication adherence in chronic heart failure patients via direct serum drug level testing.
- To identify factors associated with non-adherence in this population.
Main Methods:
- Prospective single-centre registry (LEVEL-CHF) of 274 chronic heart failure patients.
- Analysis of serum levels for angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists.
- Adherence defined by measurable serum drug levels; non-adherence by unmeasurable levels.
Main Results:
- 82.5% of patients demonstrated adherence, while 17.5% were non-adherent.
- Younger patients (<60 years) were significantly more likely to be non-adherent (OR 2.15).
- No other clinical or laboratory parameters predicted non-adherence.
Conclusions:
- A substantial proportion of chronic heart failure outpatients are non-adherent to prescribed medications when assessed directly.
- Younger age is a key predictor of non-adherence in heart failure patients.
- Serum drug level testing provides a direct and valuable method for assessing medication adherence.
Background:
Currently, most available data on the medication adherence of patients with chronic heart failure are based on indirect methods. We examined the level of adherence to medical therapy using a direct method - serum drug level testing.
Methods:
We carried out a prospective single-centre registry of patients with chronic heart failure (LEVEL-CHF registry), in whom we analysed serum levels of the medications prescribed for the treatment of heart failure: angiotensin converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists. We labelled a patient as non-adherent if at least one serum level of a prescribed drug was unmeasurable (below the detection limit). Patients with all tested drugs identifiable in serum were labelled as adherent. We enrolled 274 patients (208 men and 66 women) mean age 62 years.
Results:
82.5% of patients were adherent and 17.5% non-adherent to prescribed medications. 3.6% were completely non-adherent without any detectable drugs in serum. Patients aged <60 years were more likely to be non-adherent than older patients (OR 2.15). No other clinical or laboratory parameters predicted non-adherence.
Conclusions:
A significant proportion of outpatients with chronic heart failure were non-adherent to treatment when assessed by a direct method of serum drug level testing. Non-adherence was more likely in younger patients.
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