Comprehensive Assessment of Angiotensin Converting Enzyme Inhibitor Compliance in Patients with Heart Failure

Context

While intervention by pharmacists can improve patients’ adherence with medication regimens, limited resources prevent one-on-one counseling with all patients.  Identifying patient characteristics associated with non-compliance could help pharmacists target patients most likely to benefit from programs aimed at optimizing adherence.

Objectives

To identify patient variables associated with non-compliance of angiotensin converting enzyme (ACE) inhibitor in heart failure (HF) patients in an effort to target patients most likely to benefit from intervention.

Setting

All patients were admitted to a 400 bed teaching institution; however, data reflects the period of time prior to hospital admission.

Design

Patients admitted to St. Paul’s Hospital coronary care unit (CCU), general cardiology ward, and general medicine ward who had been taking an ACE inhibitor for at least 3 months prior to admission were approached for consent to participate in this study. An interview was carried out using a standardized survey. The survey consisted of questions relating to patient’s demographics, medication use, perceived need of ACE inhibitor therapy, traveling, deliberate alteration from prescribed regimen, use of compliance aids, rating of physician and pharmacist, cost issues and drug information sources. PharmaNet records, patient-specific prescription medication records for the past fourteen months, were obtained for compliance calculation.

Main Outcome Measures

The primary outcome was the rate of compliance to a prescribed ACE inhibitor regimen as determined by PharmaNet records. Univariate analysis was used to identify patient variables that might be individually associated with non-compliance. Multivariate logistic regression was then used to identify independent predictors of non-compliance.

Results

Eighty-eight out of ninety-nine patients were included in the study. The response to two questions were identified as independent predictors of non-compliance: “Are you careless at times about taking your medicine?” and “Have you discontinued taking any of your medications that your physician intended you to take in the past year?”. The sensitivity was 40% and the specificity was 96%. Variables which have been reported to predict non-compliance in previous studies, were not found to be independent predictors in our study.

Conclusions

The answers to two questions help target specific HF patients for interventions aimed at improving compliance. However, the results drawn are based on a relatively small sample and could be affected significantly by small changes in the pattern of respondents.

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