The therapeutic plan implementation in patients discharged from the hospital after myocardial infarction

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Introduction: Poor medication adherence is associated with unsatisfactory health outcomes, elevated mortality, and high costs of medical care. This study aimed to assess the implementation of therapeutic recommendations in high cardiovascular-risk patients based on self-report questionnaires. Material and methods:The study included 194 patients from the Cardiology Outpatient Clinic. Two self-reported questionnaires were used to assess medication adherence: the Medication Adherence Questionnaire (MAQ) and the Adherence in Chronic Diseases Scale (ACDS).Results: Antihypertensive drugs were prescribed to 65.46% of the patients. According to the MAQ, 54.33% of them reported high adherence, 21.26% medium adherence, and 24.41% low adherence to the treatment. Lipid-lowering drugs were prescribed to 46.39% of the patients, all of whom were treated with statins. Among this group, 34.44% reported high adherence, 27.78% medium adherence, and 37.78% low adherence to pharmacotherapy. According to the ACDS, the majority of patients (45.55%) received a score indicating medium adherence (21-26 points), 39.27% high adherence (> 26 points), and 16.75% low adherence to treatment (< 21 points). A high level of adherence was declared by 61.54% of the patients that reached the therapeutic goal of lipid-lowering therapy, defined as LDL-C of < 2.6 mmol/L (< 100 mg/dL). On the other hand, among the patients whose LDL-C remained elevated, 23.44% declared high adherence to treatment. There were no significant differences in achieving the intended therapeutic goal of blood pressure (BP ≤ 140/90 mmHg) in the groups with high, medium and low adherence (26.53% vs. 23.47% vs. 50.00%; p = 0.1880). Conclusion:Despite higher adherence to treatment in the patients with hypertension compared to patients with hyperlipidemia, the latter more often achieved the therapeutic goal. Declarations regarding high adherence to medication in the MAQ and in the ACDS are consistent in patients with hyperlipidemia and hypertension.

Section: Discussionmentioning

confidence: 99%

Implementation of therapeutic recommendations in high cardiovascular-risk patients. The Polish population of EUROASPIRE V survey

Laskowska

Michalski

Pietrzykowski

et al. 2021

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“…Developing a proper relation with the patient, one based on trust and active listening, as well as the use of questionnaires, can contribute to recognizing barriers involved with failure to follow therapeutic recommendations [22][23][24], however, the assessment of real adherence requires the use of more precise, objective methods.…”

Section: A Comparison Of Mean Scores From Question 1 Of the Acds And The Maq Declarationsmentioning

confidence: 99%

Ambulatory assessment of medication adherence in high cardiovascular-risk patients. The Polish population of the EUROASPIRE V survey

Michalski

Kasprzak

Pietrzykowski

et al. 2021

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Introduction: Patients' non-compliance with therapeutic recommendations is an important factor limiting the effectiveness of the treatment. This study aimed to compare patients' declarations regarding their drug intake (Medication Adherence Questionnaire) with the results of the Adherence in Chronic Disease Scale (ACDS). Material and methods:The study included 200 patients (66.5% women) without prior cardiovascular events, diagnosed with hypertension, hypercholesterolemia, or diabetes within 6-24 months before the inclusion.To assess the therapeutic plan implementation the ACDS and the MAQ questionnaires were used.Results: Based on patients' declarations, a satisfactory level of adherence (MAQ 5 and MAQ 4) was reported for 75.58% of patients treated for hypertension, 51.62% for diabetes, and 62.22% for hypercholesterolemia.A non-adherence risk assessment with the use of the ACDS yielded high results (i.e. low risk of non-adherence) in 38.58% of hypertension patients, 51.61% of diabetes patients 41.11% of hypercholesterolemia patients. Regardless of the disease, the patients indicating full (MAQ 5) or almost full (MAQ 4) therapeutic plan implementation often did not confirm that in similar question 1 of the ACDS.Conclusions: Patients' self-assessment of the implementation of a therapeutic plan poses a risk of overestimation; particularly when it is based on answering only a single question. Additional application of the ACDS seems to help assess the risk of non-adherence as well as define barriers, beliefs, and behaviors that determine it. This assessment provides the basis to take action to improve the therapeutic plan implementation.

“…Furthermore, the organization of HF management programs should be adapted to the local healthcare system, available resources, administrative policies, and tailored to the patient's needs [7]. Finally, implementing these recommendations implies the need to monitor the effectiveness of the actions taken using validated diagnostic tools to assess the readiness for discharge from the hospital, the implementation of the therapeutic plan, and functioning in chronic disease [27][28][29][30][31][32][33][34][35][36]…”

Section: The Key Role Of Sglt2 Inhibitors In the Esc Guidelinesmentioning

confidence: 99%

Dapagliflozin — a key pawn on the new guidelines chessboard

Kubica

2021

Treatment of patients with heart failure and reduced left ventricular ejection fraction (HFrEF) aims to reduce mortality, prevent rehospitalizations due to heart failure (HF) exacerbation, and improve the clinical status, functional capacity, and quality of life. All these goals were achieved in the DAPA-HF trial. In this trial, the reduction in the primary outcome, defined as a composite of worsening of HF or cardiovascular death, was achieved in patients receiving dapagliflozin [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65-0.85; p < 0.001) as compared with placebo. In addition, the beneficial effect of dapagliflozin on the primary outcome was generally consistent across prespecified subgroups regardless of baseline treatment, diagnosis of diabetes, or left ventricular ejection fraction (LVEF).Data from multiple countries was obtained in the CVD-REAL study. The use of different sodium-glucose co-transporter 2 (SGLT2) inhibitors, versus other glucose-lowering drugs, was associated with lower rates of hospitalization for HF (HR 0.61; 95% CI 0.51-0.73; p < 0.001) and death (HR 0.49; 95% CI 0.41-0.57; p < 0.001). These findings were confirmed in the CVD-REAL-2 study.The exceptional clinical benefits of SGLT2 inhibitors applied on top of the previously guideline-recommended treatment in patients with chronic HFrEF led to fundamental changes in the recommended treatment strategy proposed in the 2016 European Society of Cardiology (ESC) guidelines for the diagnosis and treatment of acute and chronic HF.To conclude, the new treatment algorithm for HFrEF is based on the findings of many groundbreaking trials. However, it is the results of trials with SGLT2 inhibitors, applied in patients with HFrEF on top of the optimal treatment including an implantable cardioverter-defibrillator and/or cardiac resynchronization therapy, that have fundamentally changed the strategy of treatment.