Patient-reported outcomes and medication adherence in patients with heart failure

• DOI: 10.1093/ehjcvp/pvaa097
• Publication Date: 2020-07-31T11:28:31Z
• Authors: Anne Ankerstjerne...; Henrik Wiggers; Martin Jensen; Selina Kikkenborg...; Trine Bernholdt R...; Britt Borregaard; Lars Thrysoee; Charlotte Brun Th...; Rikke Elmose Mols; Signe Holm Larsen; Søren Paaske Johnsen
• Keywords: Heart Failure; Patient-reported outcomes; Heart failure; Angiotensin-Converting Enzyme Inhibitors; Medication Adherence; 3. Good health; Cohort Studies; Angiotensin Receptor Antagonists; 03 medical and health sciences; 0302 clinical medicine; Quality of Life; Humans; Patient Reported Outcome Measures; Medication adherence

Abstract

Aims Patient-reported outcome measures (PROMs) may predict poor clinical outcome in patients with heart failure (HF). It remains unclear whether PROMs are associated with subsequent adherence to HF medication. We aimed to determine whether health-related quality of life, anxiety, and depression were associated with long-term medication adherence in these patients.

Methods and results A national cohort study of Danish patients with HF with 3-year follow-up (n = 1464). PROMs included the EuroQol five-dimensional, five-level questionnaire (EQ-5D-5L), the HeartQoL and the Hospital Anxiety and Depression Scale (HADS). Patient-reported outcomes (PRO) data were linked to demographic and clinical data at baseline, and data on all redeemed prescriptions for angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitors (ACEI/ARB/ARNI), β-blockers, and mineralocorticoid receptor antagonists during follow-up. Medication non-adherence was defined as <80% of proportion of days covered. In adjusted regression analyses, lower health-related quality of life (EQ-5D and HeartQoL) and symptoms of depression (HADS-D) at discharge were associated with non-adherence. After 3 years of follow-up, lower health-related quality of life (EQ-5D) was associated with non-adherence for ACEI/ARB/ARNI [adjusted OR 2.78, 95% confidence interval (CI): 1.19–6.49], β-blockers (adjusted OR 2.35, 95% CI: 1.04–5.29), whereas HADS-D was associated with non-adherence for ACEI/ARB/ARNI (adjusted OR 1.07, 95% CI: 1.03–1.11) and β-blockers (adjusted OR 1.06, 95% CI: 1.02–1.10).

Conclusion Lower health-related quality of life and symptoms of depression were associated with non-adherence across HF medications at 1 and 3 years of follow-up. Person-centred care using PROMs may carry a potential for identifying patients at increased risk of future medication non-adherence.