Adherence and perception of medication in patients with chronic heart failure during a five-year randomised trial.
OBJECTIVE
Many patients with chronic heart failure (CHF) are thought to be non-adherent to their prescribed medications. The objective was to describe perceptions about and adherence to regular medicines and study medication at baseline and study end in CHF patients participating in a clinical trial.


METHODS
In the carvedilol or metoprolol European trial (COMET), patients (N = 3029) with CHF were randomised and followed during a 58-month period. Patients at some Swedish centres answered a questionnaire at baseline and study end concerning their perception of their regular heart medication and study medication. Adherence was established through estimation of drug usage.


RESULTS
In the Swedish sub-study, 302 patients responded once to the questionnaire while 107 patients responded both at baseline and at follow-up. At baseline, 94% of the patients stated that they believed that the study medication would make them feel better and 82% believed that their regular heart medication would do so. During the study, patients' belief in their regular cardiac medication significantly increased. Lack of belief in medication at the start of the study was a strong predictor of withdrawal from the trial (64% versus 6.8%; p < 0.0001). Those patients with very poor well-being and limited functional ability (classified as NYHA III-IV) at baseline significantly (p = 0.01) increased their belief in the regular cardiac medication but not in their study medication.


CONCLUSIONS
Belief in medication may be related to how the patient experiences the medication's impact on functional ability, symptoms and well-being.


CONCLUSIONS
Early identification of patients' beliefs about medication seem to be an important factor in counselling and information to patients with CHF.
Ekman
Inger
I
The Sahlgrenska Academy, Faculty of Health and Caring Sciences, Institute of Nursing, Göteborg University, Box 457, SE 405 30, Göteborg, Sweden. inger.ekman@fhs.gu.se
Andersson
Gull
G
Boman
Kurt
K
Charlesworth
Andrew
A
Cleland
John G F
JG
Poole-Wilson
Philip
P
Swedberg
Karl
K
D000203:Activities of Daily Living; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002227:Carbazoles / Q000627:therapeutic use; D000077261:Carvedilol; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006304:Health Status; D006333:Heart Failure / Q000188:drug therapy / Q000523:psychology; D006801:Humans; D008297:Male; D008790:Metoprolol / Q000627:therapeutic use; D015337:Multicenter Studies as Topic; D010349:Patient Compliance / Q000523:psychology* / Q000706:statistics & numerical data; D010353:Patient Education as Topic; D011412:Propanolamines / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D013548:Sweden; D013997:Time Factors
D000319:Adrenergic beta-Antagonists; D002227:Carbazoles; D011412:Propanolamines; D000077261:Carvedilol; D008790:Metoprolol