Urinary drug metabolite testing in chronic heart failure patients indicates high levels of adherence with life-prolonging therapies.
Urinary drug metabolite testing in chronic heart failure patients indicates high levels of adherence with life-prolonging therapies.
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DOI：
10.1002/ehf2.13284
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发表时间：
2021-06
影响因子：
3.8
通讯作者：
Plymen CM
中科院分区：
文献类型：
--
作者：
Sweeney M;Cole GD;Pabari P;Hadjiphilippou S;Tayal U;Mayet J;Chapman N;Plymen CM
尽管心力衰竭（HF）的药物治疗已证明可改善生活质量和生存期，但许多患者仍未得到充分治疗。这可能是由于医疗专业人员处方不足和患者依从性差的综合原因。在HF中，与许多其他慢性疾病一样，药物依从性可能随着时间的推移而恶化，特别是当症状得到良好控制时。因此，检测和解决不依从性在HF的管理中起着至关重要的作用。目前用于评估依从性的方法存在重大缺陷和不准确性，例如患者报告，药丸计数和药房填充记录。我们的目的是使用高效液相色谱-串联质谱（HPLC-MS）检测慢性HF患者尿液样本中HF药物的代谢产物。从HF专科诊所的35名患者中采集尿液样本。如果患者的射血分数<45%，并且正在服用至少两种疾病缓解HF药物，则将其纳入研究。如果他们在就诊前3个月内因HF入院，则被排除在外。将这些样本送去进行HPLC-MS，并检测该患者处方的所有HF药物。在这些患者中检测到89%的高完全依从率，其中94%部分依从（至少检测到一种HF药物）治疗（至少检测到一种HF药物）。该分析还强调，盐皮质激素拮抗剂代表了处方最少（67%）和依从性最差（75%）的药物类别。这项分析显示，慢性HF患者对疾病改善治疗的依从性惊人地高，并强调我们的大部分“总”治疗不足可能是由于未能开具处方而不是未能依从。使用HPLC-MS检测尿液中改善疾病的HF药物的代谢物是可行的，并且是专家HF服务的有用辅助手段。目前，治疗失败和不接受治疗之间的区别并不总是很清楚，这一点很重要，因为调查和潜在的解决方案是不同的。前者需要启动额外的治疗和考虑额外的诊断，而后者需要了解依从性差的原因的策略，并合作改善这一点：错误的策略将是无效的。
Despite medical therapy for heart failure (HF) having proven benefits of improving quality of life and survival, many patients remain under‐treated. This may be due to a combination of under‐prescription by medical professionals and poor adherence from patients. In HF, as with many other chronic diseases, adherence to medication can deteriorate over time particularly when symptoms are well controlled. Therefore, detecting and addressing non‐adherence has a crucial role in the management of HF. Significant flaws and inaccuracies exist in the methods currently used to assess adherence such as patient reporting, pill counts, and pharmacy fill records. We aim to use high‐performance liquid chromatography–tandem mass spectrometry (HPLC‐MS) to detect metabolites of HF medications in the urine samples of chronic HF patients. Urine samples were collected from 35 patients in a specialist HF clinic. Patients were included if they had an ejection fraction <45% and were taking at least two disease‐modifying HF medications. They were excluded if they had been admitted to hospital for HF in the 3 months preceding clinic attendance. These samples were sent for HPLC‐MS and tested for all HF medications prescribed for that patient. A high rate of complete adherence of 89% was detected in these patients, with 94% being partially adherent (at least one HF medication detected) to therapy (at least one HF medication detected). This analysis also highlighted that mineralocorticoid antagonists represent both the most under‐prescribed (67%) and poorly adhered (75%) medication class. This analysis revealed a surprisingly high level of adherence to disease‐modifying therapy in chronic HF patients and highlights that most of our ‘total’ under‐treatment is likely to be from a failure to prescribe rather than a failure to adhere. Testing for metabolites of disease‐modifying HF drugs in urine using HPLC‐MS is feasible and is a useful adjunct to a specialist HF service. At present, the distinction between treatment failure and failure to take treatment is not always clear, which is important because the investigation and potential solutions are different. The former needs initiation of additional therapies and consideration of additional diagnoses, whereas the latter requires strategies to understand reasons underlying poor adherence and collaborative working to improve this: the wrong strategy will be ineffective.
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影响因子：
--
作者：
Beattie JM;Higginson IJ;McDonagh TA
通讯作者：
McDonagh TA
影响因子：
105.7
作者：
Vrijens, Bernard;Vincze, Gabor;Burnier, Michel
通讯作者：
Burnier, Michel
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作者：
Fitzgerald, Ashley A.;Powers, J. David;Havranek, Edward P.
通讯作者：
Havranek, Edward P.
影响因子：
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作者：
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通讯作者：
McElnay, JC
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2
作者：
Nieuwenhuis, M. M. W.;Jaarsma, T.;van der Wal, M. H. L.
通讯作者：
van der Wal, M. H. L.