title: Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients.
abstract: BACKGROUND
  Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF.
  
  
  METHODS
  Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n = 44), a nurse conducted self-management training before discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom response plan. The attention control group (n = 42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point.
  
  
  RESULTS
  Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio 3.92, t = 3.51, P = .0007).
  
  
  CONCLUSIONS
  A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.
authors.affiliation: Duke University School of Nursing, Durham, NC; Duke University Health Systems, Durham, NC. Electronic address: bradi.granger@dm.duke.edu.
authors.forename: Bradi B
authors.initials: BB
authors.lastname: Granger
authors.affiliation: Institute of Health and Care Sciences, Centre for Person-Centred Care, University of Gothenburg, Göteborg, Sweden.
authors.forename: Inger
authors.initials: I
authors.lastname: Ekman
authors.affiliation: Duke Clinical Research Institute, Duke Medicine, Durham, NC.
authors.forename: Adrian F
authors.initials: AF
authors.lastname: Hernandez
authors.affiliation: Duke University Health Systems, Durham, NC.
authors.forename: Tenita
authors.initials: T
authors.lastname: Sawyer
authors.affiliation: Duke University School of Nursing, Durham, NC; Duke University Health Systems, Durham, NC.
authors.forename: Margaret T
authors.initials: MT
authors.lastname: Bowers
authors.affiliation: Duke University Health Systems, Durham, NC.
authors.forename: Tracy A
authors.initials: TA
authors.lastname: DeWald
authors.affiliation: SAS Institute, Cary, NC.
authors.forename: Yanfang
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Duke University School of Nursing, Durham, NC.
authors.forename: Janet
authors.initials: J
authors.lastname: Levy
authors.affiliation: Center for Health Services Research in Primary Care, VA Medical Center, Durham, NC.
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000401:mortality; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012648:Self Care / Q000379:methods*; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D002317:Cardiovascular Agents
references.citation: Eur J Cardiovasc Nurs. 2007 Jun;6(2):99-104
references.pmid: 16831569
references.citation: Nurs Clin North Am. 2008 Mar;43(1):133-53; vii-viii
references.pmid: 18249229
references.citation: Br J Clin Pharmacol. 2005 Aug;60(2):183-93
references.pmid: 16042672
references.citation: Soc Sci Med. 2005 Jul;61(1):133-55
references.pmid: 15847968
references.citation: Cochrane Database Syst Rev. 2008 Apr 16;(2):CD000011
references.pmid: 18425859
references.citation: Eur J Heart Fail. 2002 Jun;4(3):283-7
references.pmid: 12034153
references.citation: Am Heart J. 2014 Jan;167(1):51-58.e5
references.pmid: 24332142
references.citation: J Clin Hypertens (Greenwich). 2008 May;10(5):348-54
references.pmid: 18453793
references.citation: BMC Nurs. 2014 Oct 08;13:28
references.pmid: 25309128
references.citation: N Engl J Med. 2005 Aug 4;353(5):487-97
references.pmid: 16079372
references.citation: Circ Cardiovasc Qual Outcomes. 2013 Mar 1;6(2):171-7
references.pmid: 23386663
references.citation: Prof Case Manag. 2014 Sep-Oct;19(5):224-34
references.pmid: 25084077
references.citation: Value Health. 2013 Jul-Aug;16(5):891-900
references.pmid: 23947984
references.citation: Heart Lung Circ. 2009 Dec;18(6):388-92
references.pmid: 19648058
references.citation: Am Heart J. 2006 Sep;152(3):454.e1-8
references.pmid: 16923412
references.citation: Circulation. 2012 Jan 3;125(1):e2-e220
references.pmid: 22179539
references.citation: Patient Educ Couns. 2006 Jun;61(3):348-53
references.pmid: 16139468
references.citation: Ann Intern Med. 2007 May 15;146(10):714-25
references.pmid: 17502632
references.citation: Cochrane Database Syst Rev. 2012 Sep 12;(9):CD002752
references.pmid: 22972058
references.citation: Cult Med Psychiatry. 1981 Dec;5(4):373-7
references.pmid: 6173162
references.citation: J Psychosom Res. 1999 Dec;47(6):491-5
references.pmid: 10661596
references.citation: J Med Internet Res. 2013 Mar 11;15(3):e53
references.pmid: 23478028
references.citation: Eur J Cardiovasc Nurs. 2013 Jun;12(3):276-83
references.pmid: 22653088
references.citation: J Psychosom Res. 1999 Dec;47(6):555-67
references.pmid: 10661603
references.citation: Ann Intern Med. 2002 Mar 19;136(6):471-6
references.pmid: 11900500
references.citation: Cochrane Database Syst Rev. 2014 Apr 29;(4):CD007768
references.pmid: 24777444
references.citation: J Cardiovasc Nurs. 2009 Sep-Oct;24(5):371-9
references.pmid: 19707097
references.citation: Am Heart J. 2010 Mar;159(3):406-13
references.pmid: 20211302
references.citation: BMJ. 2003 Oct 11;327(7419):837
references.pmid: 14551097
references.citation: Eur Heart J. 2012 May;33(9):1112-9
references.pmid: 21926072
references.citation: Lancet. 2005 Dec 10;366(9502):2005-11
references.pmid: 16338449
references.citation: Am J Geriatr Pharmacother. 2009 Apr;7(2):105-16
references.pmid: 19447363
references.citation: Health Expect. 2004 Sep;7(3):235-45
references.pmid: 15327462
references.citation: Heart Lung. 2008 Jan-Feb;37(1):8-16, 16.e1
references.pmid: 18206522
references.citation: J Gen Intern Med. 2013 Jul;28(7):938-42
references.pmid: 23404203
references.citation: J Cardiovasc Nurs. 2009 Jul-Aug;24(4):308-15
references.pmid: 19465865
references.citation: Circulation. 2006 Jan 17;113(2):203-12
references.pmid: 16401776
references.citation: J Card Fail. 2005 May;11(4):288-92
references.pmid: 15880338