Predictors of objectively measured medication nonadherence in adults with heart failure.
BACKGROUND
Medication nonadherence rates are high. The factors predicting nonadherence in heart failure remain unclear.


RESULTS
A sample of 202 adults with heart failure was enrolled from the northeastern United States and followed for 6 months. Specific aims were to describe the types of objectively measured medication adherence (eg, taking, timing, dosing, drug holidays) and to identify contributors to nonadherence 6 months after enrollment. Latent growth mixture modeling was used to identify distinct trajectories of adherence. Indicators of the 5 World Health Organization dimensions of adherence (socioeconomic, condition, therapy, patient, and healthcare system) were tested to identify contributors to nonadherence. Two distinct trajectories were identified and labeled persistent adherence (77.8%) and steep decline (22.3%). Three contributors to the steep decline in adherence were identified. Participants with lapses in attention (adjusted OR, 2.65; P=0.023), those with excessive daytime sleepiness (OR, 2.51; P=0.037), and those with ≥2 medication dosings per day (OR, 2.59; P=0.016) were more likely to have a steep decline in adherence over time than to have persistent adherence.


CONCLUSIONS
Two distinct patterns of adherence were identified. Three potentially modifiable contributors to nonadherence have been identified.
Biobehavioral Research Center, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA. briegel@nursing.upenn.edu
Barbara
B
Riegel
Christopher S
CS
Lee
Sarah J
SJ
Ratcliffe
Sabina
S
De Geest
Sheryl
S
Potashnik
Megan
M
Patey
Steven L
SL
Sayers
Lee R
LR
Goldberg
William S
WS
Weintraub
D000368:Aged; D001288:Attention; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D016009:Chi-Square Distribution; D006970:Disorders of Excessive Somnolence / Q000453:epidemiology; D004334:Drug Administration Schedule; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009511:New England / Q000453:epidemiology; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012648:Self Care; D013997:Time Factors
D002317:Cardiovascular Agents