Cardiovascular Medication Utilization and Adherence Among Heart Failure Patients in Rural and Urban Areas: A Retrospective Cohort Study

Murphy, Gaetanne K; McAlister, Finlay A.; Eurich, Dean T.

doi:10.1016/j.cjca.2014.11.024

Cited by 22 publications

(27 citation statements)

References 13 publications

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“…The same finding was observed in a systematic review and meta-analysis [33]. A retrospective cohort study conducted in Canada also noted that there was no difference in drug adherence between urban and rural residents [34]. …”

Section: Discussionsupporting

confidence: 75%

Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia

Mekonnen

Gebrie

Eyasu

et al. 2017

BMC Pharmacol Toxicol

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BackgroundAdherence to prescribed medication is an imperative issue which can be directly linked with the management of chronic diseases like hypertension; failure to adhere can affect the effectiveness of medication as well as the efficiency of the health care system. There is scarcity of information regarding the level of drug adherence for antihypertensive medications and its determinants in Ethiopia, particularly in the study area. Therefore, the aim of this study was to assess adherence level and its determinants for antihypertensive medications among adult hypertensive patients attending the chronic illness clinics of the referral hospitals in northwest Ethiopia.MethodsInstitution based cross sectional study was conducted from March to April, 2016. The systematic random sampling technique was used to select 409 study participants from three referral hospitals. The questionnaire was prepared using the World Health Organization (WHO) conceptual model and by reviewing international literature. The data were collected using an interviewer administered questionnaire. The data were entered in to Epi - Info version 7 and then transferred to the statistical package for social science (SPSS) version 20 for data cleaning and analysis.Bivariate analysis was first done to see the association between each independent variables and dependent variable. Variables with a P-value of less than 0.2 in the bivariate analysis were entered in to the multivariate logistic regression model for final analysis. Multivariate analysis was done using Backward logistic regression method. P-value less than 0.05 was considered to determine the statistical significance of the association and odds ratio with a 95% confidence interval was used to determine the presence, strength, and direction of association between covariates (explanatory variables) and the outcome variable. The Morisky medication adherence scale was used to assess the adherence status using > = 6 as adherent or < 6 as non adherent score.ResultsFour hundred and nine (409) study participants were interviewed with a response rate of 100%. The mean age of the respondents was 54.5 years with (Standard Deviation (SD) ± 13.58). The overall rate of good adherence was 67.2% (95% CI = 62.8, 71.6). Participants who had a favourable attitude towards antihypertensive medications (Adjusted odds ratio (AOR) = 9.88, 95% confidence interval (CI): 5.34, 18.27), having good patient- provider relationship (AOR = 4.25, 95% CI: 2.32, 7.86), having one (AOR = 4.36, 95% CI: 1.34, 14.12) or no (AOR = 3.38, 95% CI:1.01,11.31) co-morbidities, a long duration of treatment (AOR = 1.89, 95%CI: 1.07, 3.35), and a low medical cost (AOR = 2.06, 95% CI: 1.13, 3.76) had associations with good drug adherence for antihypertensive medication/s.ConclusionsThe prevalence of good drug adherence for anti-hypertensive medications in this study was high. Prevention of co- morbidities, making medical services accessible, and maintaining good client-provider interaction are of paramount importance for good drug adherence.

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Section: Discussionsupporting

confidence: 75%

Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia

Mekonnen

Gebrie

Eyasu

et al. 2017

BMC Pharmacol Toxicol

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“…The included studies focussed on a wide range of disease areas including pulmonary diseases, osteoporosis, depression, cardiovascular diseases, Parkinson's disease, epilepsy, chronic kidney disease, cancer and diabetes mellitus . Two studies did not measure disease‐specific medication (non‐)adherence .…”

Section: Resultsmentioning

confidence: 99%

“…Two studies did not measure disease‐specific medication (non‐)adherence . Thirty‐six studies were specific to, or provided age stratified analysis for people aged ≥64 years, while the other 30 studies also included middle aged adults (≥50 years) . Thirteen authors of the included texts were contacted via e‐mail for further information, and 8 replied.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen authors of the included texts were contacted via e‐mail for further information, and 8 replied. In terms of adherence measurement, 54 studies measured medication (non‐)adherence using pharmacy claims data while 11 studies used self‐report methods, consisting of the 4‐item or 8‐item Morisky Medication Adherence Scale, or self‐reported PDC and MEMs was used in 4 studies …”

Section: Resultsmentioning

confidence: 99%

“…Overall, 48 studies were determined to be high quality, 17 were determined to be medium quality and 1 study was deemed to be low quality (Table S8). There was considerable variability with regards to external validity (generalisability), with 15 studies deemed medium quality and 11 studies achieving low quality .…”

Section: Resultsmentioning

confidence: 99%

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The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

Walsh

Cahir

Tecklenborg

et al. 2019

Brit J Clinical Pharma

152

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Aims The aim of this systematic review and meta‐analysis was to synthesise the evidence relating to medication non‐adherence and its association with health outcomes in people aged ≥50 years. Methods Seven databases were searched up to February 2019 for observational studies that measured medication (non‐)adherence as a predictor of the following health outcomes in adults aged ≥50 years: healthcare utilisation (hospitalisation, emergency department visits, outpatient visits and general practitioner visits), mortality, adverse clinical events and quality of life. Screening and quality assessment using validated criteria were completed by 2 reviewers independently. Random effects models were used to generate pooled estimates of association using adjusted study results. The full methodological approach was published on PROSPERO (ID: CRD42017077264). Results Sixty‐six studies were identified for qualitative synthesis, with 11 of these studies eligible for meta‐analyses. A meta‐analysis including 3 studies measuring medication non‐adherence in adults aged ≥55 years showed a significant association with all‐cause hospitalisation (adjusted odds ratio 1.17, 95% confidence interval [CI] 1.12, 1.21). A meta‐analysis including 2 studies showed that medication non‐adherence was not significantly associated with an emergency department visit (adjusted odds ratio 1.05, 95% CI 0.90, 1.22). Good adherence was associated with a 21% reduction in long‐term mortality risk in comparison to medication non‐adherence (adjusted hazard ratio 0.79, 95% CI 0.63, 0.98). Conclusion Medication non‐adherence may be significantly associated with all‐cause hospitalisation and mortality in older people. Medication adherence should be monitored and addressed in this cohort to minimise hospitalisation, improve clinical outcomes and reduce healthcare costs.

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Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

et al. 2019

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Aims This study aims to determine if traditional markers of disadvantage [female sex, low socio-economic status (SES), and remoteness] are associated with lower prescription of evidence-based therapy and higher mortality among patients with moderate-severe heart failure with reduced ejection fraction. Methods and resultsWe recruited 452 consecutive class II-III heart failure with reduced ejection fraction patients. Baseline clinical data were recorded prospectively. The primary outcome was the association of female sex on overall survival. Secondary outcomes included association between evidence-based therapy delivery and sex and association of SES and remoteness on heart failure therapy and survival. The Australian Bureau of Statistics generated all indices. Median follow-up was 37.9 months. One hundred and nine patients (24.3%) were women. There was no difference in overall survival based on sex (hazard ratio = 1.19, 95% confidence interval: 0.74-1.92, 0.48). There was no difference in prescription of beta-blockers [χ 2 (1) = 0.91, 0.66], angiotensin-converting enzyme inhibitors [χ 2 (1) = 0.001, 0.97], nor aldosterone antagonists [χ 2 (1) = 2.71, 0.10]. There was no difference in rates of primary prevention implantable cardioverter-defibrillator implantation in men compared with women [χ 2 (1) = 0.35, 0.56]. Neither higher SES nor inner city residence conferred an overall survival benefit. Conclusions In this Australian cohort of heart failure patients, delivery of care and likelihood of death are comparable between the sexes, SES groups, and rural vs. city residents.

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Cardiovascular Medication Utilization and Adherence Among Heart Failure Patients in Rural and Urban Areas: A Retrospective Cohort Study

Cited by 22 publications

References 13 publications

Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia

Drug adherence for antihypertensive medications and its determinants among adult hypertensive patients attending in chronic clinics of referral hospitals in Northwest Ethiopia

The association between medication non‐adherence and adverse health outcomes in ageing populations: A systematic review and meta‐analysis

Impact of sex, socio‐economic status, and remoteness on therapy and survival in heart failure

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