Self-reported versus 'true' adherence in heart failure patients: a study using the Medication Event Monitoring System
Self-reported versus 'true' adherence in heart failure patients: a study using the Medication Event Monitoring System
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DOI：
10.1007/s12471-012-0283-9
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发表时间：
2012-08-01
影响因子：
2
通讯作者：
van der Wal, M. H. L.
中科院分区：
文献类型：
--
作者：
Nieuwenhuis, M. M. W.;Jaarsma, T.;van der Wal, M. H. L.
坚持（非）药物治疗对心力衰竭（HF）患者很重要，因为它会导致更好的临床结局。虽然在既往研究中比较了HF患者自我报告和客观测量的药物依从性，但这些研究均未使用循证临界点来区分依从性和非依从性。（平均年龄68 ± 10岁，27%女性，40% NYHA心功能分级III-IV），使用药物事件监测系统（MEMS）客观地测量药物（ACEi/ARB）依从性。使用修订的HF依从性问卷通过自我报告评估服药的依从性和重要性。所有患者均报告依从性对他们（高度）重要，并且他们“总是”按处方服药（即100%依从性）。然而，当通过MEMS测量时，只有76%的患者是粘附的。与依从性患者相比，非依从性患者更常有复杂的药物治疗方案（78% vs. 21%，P <0.01），更常有抑郁症状（75% vs. 29%，P = 0.04）和较短的HF病史（8 vs. 41个月，P = 0.04）。MEMS测量的药物依从性显著低于自我报告的依从性。鉴于其重要性的证据，需要进一步的努力来提高HF患者对药物治疗方案的依从性。
Adherence to (non)pharmacological treatment is important in heart failure (HF) patients, since it leads to better clinical outcome. Although self-reported and objectively measured medication adherence in HF patients have been compared in previous studies, none of these studies have used an evidence-based cutpoint to differentiate between adherence and non-adherence.In 37 HF patients (mean age 68 +/- 10 years, 27 % female, 40 % NYHA functional class III-IV), medication (ACEi/ARB) adherence was objectively measured using the Medication Event Monitoring System (MEMS). Adherence to and importance of taking medication was also assessed by self-report using the Revised HF Compliance Questionnaire.All patients reported that adherence was (highly) important to them and that they 'always' took their medication as prescribed (i.e. 100 % adherence). However, when measured by the MEMS, only 76 % of all patients were adherent. Non-adherent patients more often had a complex medication regimen (78 % vs. 21 %, P < .01), more often depressive symptoms (75 % vs. 29 %, P = .04) and a shorter history of HF (8 vs. 41 months, P = .04), compared with adherent patients.Medication adherence measured by the MEMS was remarkably lower than self-reported adherence. Given the evidence of its importance, further efforts are needed to improve adherence to the pharmacological regimen in HF patients.