Medication Adherence Among Community-Dwelling Patients With Heart Failure

Dunlay, Shannon M.; Eveleth, Jessica M.; Shah, Nilay D.; McNallan, Sheila M; Roger, Véronique L.

doi:10.4065/mcp.2010.0732

Cited by 82 publications

(58 citation statements)

References 41 publications

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“…We here adapted our analyses according to the proposed 80% threshold [15]. Since this was a home-based protocol, an ongoing supervision was impossible and the adherence was highly variable as it is often the case with home-based studies [25]. In the future, combined interventions (e.g., tDCS during physical therapy) could be a valuable therapeutic approach to reduce the amount of missed sessions, even more since tDCS combined with other rehabilitation procedures can have greater effects [26e28].…”

Section: G Martens Et Al / Brain Stimulation XXX (2018) 1e9mentioning

confidence: 99%

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Martens¹,

et al. 2018

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a b s t r a c tBackground: Patients with chronic disorders of consciousness face a significant lack of treatment options. Objective: We aimed at investigating the feasibility and the behavioral effects of home-based transcranial direct current stimulation (tDCS), applied by relatives or caregivers, in chronic patients in minimally conscious state (MCS). Methods: Each participant received, in a randomized order, 20 sessions of active and 20 sessions of sham tDCS applied over the prefrontal cortex for 4 weeks; separated by 8 weeks of washout. Level of consciousness was assessed using the Coma Recovery Scale-Revised before the first stimulation (baseline), at the end of the 20 tDCS sessions (direct effects) and 8 weeks after the end of each stimulation period (long-term effects). Reported adverse events and data relative to the adherence (i.e., amount of sessions effectively received) were collected as well. Results: Twenty-seven patients completed the study and 22 patients received at least 80% of the stimulation sessions. All patients tolerated tDCS well, no severe adverse events were noticed after real stimulation and the overall adherence (i.e., total duration of stimulation) was good. A moderate effect size (0.47 and 0.53, for modified intention to treat and per protocol analysis, respectively) was observed at the end of the 4 weeks of tDCS in favor of the active treatment. Conclusions: We demonstrated that home-based tDCS can be used adequately outside a research facility or hospital by patients' relatives or caregivers. In addition, 4 weeks of tDCS moderately improved the recovery of signs of consciousness in chronic MCS patients.© 2018 Elsevier Inc. All rights reserved. IntroductionPatients who suffered from a severe brain injury and stay with a disorder of consciousness (DOC) represent a challenging population to treat since, by definition, these patients are unable to communicate, and therefore to participate in active rehabilitation programs. Currently, their treatment options are limited, especially in the chronic setting. Several drugs to improve the level of consciousness have been studied (e.g., zolpidem, levodopa or baclofen) [1]. However, so far, only amantadine showed significant clinical effects [2]. Recently, transcranial direct current stimulation (tDCS) showed promising results in patients in a minimally conscious state (MCS e i.e., showing fluctuating but reproducible signs of consciousness, such as response to command or visual pursuit for instance, while being unable to functionally communicate) while patients in unresponsive wakefulness syndrome (UWS e i.e., only showing cyclic eye-opening and reflexive behaviors) seem to be less responsive to that treatment. We demonstrated that a single session of tDCS, applied with the anode over the left dorsolateral prefrontal cortex (DLPFC) and the cathode over the contralateral supraorbital area, induced transient clinical improvement [4], as

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Section: G Martens Et Al / Brain Stimulation XXX (2018) 1e9mentioning

confidence: 99%

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Martens¹,

et al. 2018

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“…The prevalence rate of depression has been reported to be as high as 25% (outpatient) and 70% (inpatient) for people with HF (Lossnitzer et al, 2012; Rutledge et al, 2006). Medication nonadherence is a primary reason for poor medical outcomes among individuals with HF (Dunlay, Eveleth, Shah, McNallan, & Roger, 2011; Esposito, Bagchi, Verdier, Bencio, & Kim, 2009) and these high rates of depression and anxiety may have an effect on medication adherence and patient health.…”

Section: Introductionmentioning

confidence: 99%

The Role of Depression in Medication Adherence Among Heart Failure Patients

et al. 2013

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The purpose of the study was to explore the association between depression and medication adherence in heart failure (HF) patients. Studies have shown that people with depression are likely to be nonadherent to their prescribed medication treatment. But other studies suggest that nonadherence may be overestimated by people with depression. A total of 244 adults with Stage C HF completed the study. Self-reported medication adherence was obtained using the Basel Assessment of Adherence Scale (BAAS); objective data on medication adherence were collected using the electronic Medication Event Monitoring System (MEMS). Depression was measured via self-report with the Patient Health Questionnaire (PHQ-9). There was a significant difference between depressed and nondepressed participants in self-reported medication nonadherence (p = .008), but not in objectively measured medication nonadherence (p = .72). The depressed sample was 2.3 times more likely to self-report poor medication adherence than those who were nondepressed (p = .006).

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“…Due to inclusion of drugs such as vitamins or health drinks, the average number of prescribed medications per patient was higher in the present study compared to the number of medications reported in patients with HF in other studies. [16–18] Anxiety and depression were more common in the high illness severity subjects than in low illness severity subjects in the present study. This is not surprising, as patients with HF who are severely ill tend to be anxious about their disease status and depressed about their quality of life.…”

Section: Discussionmentioning

confidence: 40%

Use of a homecare electronic health record to find associations between patient characteristics and re-hospitalizations in patients with heart failure using telehealth

et al. 2013

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Summary Data from homecare electronic health records were used to explore the association of patient characteristics with re-hospitalizations of patients with heart failure (HF) during a 60-day period of telemonitoring following hospital discharge. Data from 403 Medicare patients with HF who had used telehealth from 2008 to 2010 were analysed. There were 112 all-cause (29%) and 73 cardiac-related (19%) re-hospitalizations within 60 days of being admitted to the homecare agency. In adjusted analyses, the patients’ prescribed number of medications and type of prescribed cardiac medications were significantly (P<0.05) associated with increased risk of re-hospitalization. After stratifying the sample by illness severity, age and gender, other significant (P<0.05) predictors associated with increased risk of all-cause and cardiac re-hospitalization were psychiatric co-morbidity, co-morbidities related to pulmonary and obesity within gender, beta blocker prescription in females and primary HF diagnosis in the oldest age stratum. The study’s findings may assist homecare agencies seeking to allocate resources without compromising patient care.

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Medication Adherence Among Community-Dwelling Patients With Heart Failure

Cited by 82 publications

References 41 publications

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

Randomized controlled trial of home-based 4-week tDCS in chronic minimally conscious state

The Role of Depression in Medication Adherence Among Heart Failure Patients

Use of a homecare electronic health record to find associations between patient characteristics and re-hospitalizations in patients with heart failure using telehealth

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