Journal
CIRCULATION-HEART FAILURE
Volume 5, Issue 4, Pages 430-436Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCHEARTFAILURE.111.965152
Keywords
heart failure; medication adherence; patient compliance; self-care; sleep; World Health Organization
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Funding
- National Heart, Lung & Blood Institute [RO1 HL084394-01A1]
- Philadelphia Veterans Affairs Medical Center, VISN 4 Mental Illness Research, Education, and Clinical Center (MIREC)
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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. (Circ Heart Fail. 2012; 5: 430-436.)
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