Understanding diuretic nonadherence among patients with heart failure: A mixed-methods study

Area of Science:

• Cardiology
• Patient Adherence Research
• Health Psychology

Background:

• Heart failure (HF) is a leading cause of hospital readmissions.
• Diuretic therapy is crucial for managing HF symptoms and preventing readmissions.
• Nonadherence to diuretic medication is a significant challenge in HF management.

Purpose of the Study:

• To quantify diuretic nonadherence in patients with 90-day HF hospital readmissions.
• To explore the multifaceted reasons behind diuretic nonadherence in this population.

Main Methods:

• Convergent parallel mixed-method design integrating quantitative and qualitative data.
• Utilized the Domains of Subjective Extent of Nonadherence scale for quantitative assessment.
• Employed semi-structured interviews for in-depth qualitative exploration of patient experiences.
• Applied descriptive and regression tests for quantitative analysis and thematic analysis for qualitative data.
• Developed meta-inferences by merging quantitative and qualitative findings.

Main Results:

• Sixty-one percent of the 82 adult participants exhibited diuretic nonadherence.
• Meta-inferences revealed nonadherence as a spectrum, not purely intentional or unintentional.
• Fear of dignity loss emerged as a significant factor contributing to nonadherence.
• Diuretic nonadherence was identified as an act of self-determination by patients.

Conclusions:

• Diuretic nonadherence in heart failure patients is complex, involving both conscious and unconscious motivations.
• Preserving dignity and asserting self-determination appear to be critical drivers influencing medication adherence.
• Clinicians and researchers should consider these psychological factors to improve adherence strategies and reduce heart failure readmissions.