Assessment of Medication Adherence Among Heart Failure Patients in an Ambulatory Care Setting: A Prospective Observational Study.

BackgroundMedication non-adherence is a critical problem among patients with heart failure (HF). Current evidence has shown its association with increased morbidity, mortality and healthcare costs. Prescription discrepancy is a significant risk factor that can increase non-adherence and subsequently increases the risk of HF-related hospitalization and mortality. Current literature has not provided a clear understanding of the non-adherence problem or contributing factors among Saudi HF patients. Measuring the prevalence of non-adherence and its associated factors can direct clinicians to implement effective interventions to optimize pharmacotherapy benefits, and thus, improving outcomes. AimTo assess the Saudi Arabian population of HF patients for degree of adherence to their medications, the amount of medication discrepancies, and its association with re-hospitalization rate. MethodA prospective observational study conducted at a tertiary care hospital on eligible HF patients attending the ambulatory clinic from July 2023 through April 2024. All patients were followed for six months. Primary outcomes were percentage of patients adherent to their medications and number and type of prescription discrepancies. Secondary outcomes were degree of health literacy, prevalence of non-adherence risk factors, and HF-related re-hospitalization rate. Adherence was measured utilizing the Eight-item Morisky Medication Adherence Scale (MMAS-8). Three-item Brief Health Literacy Screen (BHLS) was used to measure health literacy. ResultA total of 202 patients were included in the study. Average age was 60 years, and 69% were males. For the primary outcomes, 43.5% of patients demonstrated high adherence, while 39.6% and 16.8% fell into medium and low adherence categories, respectively. Prescription discrepancies were identified in 51.5% of the patients. Causes of discrepancies ranged from patient generated, healthcare system generated, or multifactorial, generated by both, the patient and the system. Degree of health literacy was adequate in 23.8% of the patients, marginal and inadequate in 51.5% and 24.8%, respectively. Of potential non-adherence risk factors, polypharmacy, age [≥]65 years, and marginal and inadequate health literacy, were the most common. HF-related re-hospitalization occurred in 18 patients, all of which were either non-adherent or had prescription discrepancies. ConclusionAmong HF patients, medication non-adherence is a significant problem that is associated with increased morbidity and mortality. In our study, around half of the patients either experienced difficulties with adherence, prescription discrepancies, or both. Measuring the local prevalence of factors affecting non-adherence can be of use to identify strategies that suit our population the best, in order to mitigate their negative effect.