Adherence to therapy and the risk of cardiovascular events in patients with heart failure: data from the outpatient registry

Abstract

Aim. To determine the adherence to drug therapy and the prevalence of cardiovascular events (CVEs) in patients with heart failure (HF) after a 1-year follow-up in a specialized cardiology unit of a research center.Material and methods. CVEs were analyzed within the prospective observational study COMPLIANCE (Assessment of adherenСe tO Medical theraРy and its infLuence on long-term outcomes In pAtieNts with Chronic hEart failure in the outpatient registry). The study included 72 patients with HF, verified according to clinical guidelines. Patients were divided into 2 groups: adherent and non-adherent to treatment. Overall adherence to therapy and adherence to specific drugs were assessed using the original National Society for Evidence-Based PharmacotherapyAdherence Scale. The study included 2 visits: inclusion in the study and a visit after 1-year follow-up. After a 1-year follow-up, a comparative analysis of the two groups was performed to achieve the primary composite endpoint: death, acute cerebrovascular accident, myocardial infarction, decompensated HF with and without hospitalization.Results. A Kaplan-Meier analysis of 1-year survival showed that the mean time to onset of primary composite endpoint was 10,2 (95% confidence interval: 9,5-10,8) months. A significant relationship was found between the occurrence of composite endpoint and adherence to angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (p=0,001), which was not confirmed for beta-blockers and mineralocorticoid receptor antagonists (p=0,338 and p=0,335, respectively). The risk of composite endpoint was 3,6 times higher in non-adherent patients than in adherent patients (hazard ratio, 3,6; 95% confidence interval, 1,5-8,5 (p=0,003)).Conclusion. A significant relationship was found between nonadherence to treatment and the incidence of CVEs, the risk of which increases by 3,6 times in non-adherent patients compared with adherent patients with HF.

Evidence-based pharmacotherapy in cardiology. National guideline

“…Влияние приверженности на исходы заболевания Крупных исследований (а они могут быть только наблюдательными) по изучению влияния приверженности на исходы заболевания нет. В небольшом когортном исследовании у больных ХСН были выявлены статистически достоверные различия в выживаемости между приверженными и неприверженными к терапии основными ЛП [243].…”

Drug related problems. Classification. Prevention methods

“…В когортном исследовании у 72 больных с хронической сердечной недостаточностью было показано, что плохая приверженность к терапии, основанной на современных клинических рекомендациях, существенно увеличивала риск возникновения первичной комбинированной конечной точки -смерти, нефатального инфаркта миокарда, нефатального инсульта, декомпенсации хронической сердечной недостаточности [36].…”