Serum drug levels to diagnose non-adherence in acute decompensated heart failure

Abstract

Background. The aim of this study was to analyze medication non-adherence by measuring serum drug levels (SDL) in patients presenting with acute decompensated heart failure (ADHF). Methods. Included in the study were chronic heart failure patients presenting with signs of acute decompensation. Blood sampling for the measurement of SDL was performed shortly after presentation. SDL were measured using liquid chromatography coupled with mass spectrometry. The estimation of SDL was calculated from the recommended chronic cardiac medications with the exception of drugs administered as part of the acute treatment prior to blood sampling. The patients were labeled as non-adherent when any one of the evaluated medications was not found in the serum. Results. Fifty patients with ADHF were prospectively enrolled. All of the evaluated drugs were detected in the sera of 28 (56%) patients. Non-adherence was diagnosed in the remaining 22 (44%) patients. None of the evaluated medications was detected in the sera of 5 (10%) patients. Conclusion. The estimation of SDL indicates that non-adherence to the recommended chronic therapy is a common problem among patients presenting with ADHF. This method should be an essential aspect of routine clinical evaluation in these patients.

The Assessment of Serum Drug Levels to Diagnose Non-Adherence in Stable Chronic Heart Failure Patients

“…However, to the best of our knowledge, the use of this method in stable CHF patients has not been reported before. We have only proved the non-adherence in significant part (44%) of patients presenting with acute decompensated heart failure using SDL monitoring in our previous study (22).…”

“…The detection of the analysed substances was accomplished on a linear ion-trap mass spectrometer (LTQ XL, Thermo Scientific, San Jose, CA, USA) using electrospray ionization. All the procedures were performed as described before (12,22).…”

Patient compliance and physicians’ adherence to guidelines on heart failure with reduced ejection fraction

“…Низкая приверженность пациентов с ХСН к лечению значимо варьирует в клинических исследованиях и составляет от 10% до 98% в зависимости от методов оценки -использования субъективных самоотчетов или объективных измерений с помощью подсчета количества таблеток или электронных систем мониторинга приема лекарств (MEMS-устройства). Применение прямых методов детекции плазменных концентраций ЛП: антагонисты рецепторов ангиотензина II (АРА), β-АБ, фуросемид, спиронолактон, тиазидные диуретики, с помощью жидкостной хроматографии и масс-спектрометрии показывают наличие препаратов у 56% пациентов с декомпенсацией ХСН, а их полное отсутствие у 10% пациентов [5,6].…”