BACKGROUND:Patients with heart failure (HF) face challenges complying with multidrug regimens. OBJECTIVES: To examine the impact of a compliance enhancing intervention on medication compliance and morbidity in HF. DESIGN: Patients were randomized to either usual care or an inhospital educational intervention delivered by a multidisciplinary team (Intervention). SETTING: Acute medical and surgical units at a teaching hospital. PATIENTS: One hundred thirty four patients with a clinical diagnosis of HF and a left ventricular ejection fraction of < 40% requiring long-term medical treatment. MAIN OUTCOME MEASURES: A validated HF-specific instrument provided a measure of knowledge. We characterized patients as noncompliant if pharmacy refill data suggested they had taken < or = 0.80 of their medication. We measured quality of life using the Minnesota Living with Heart Failure Questionnaire and the Short Form 36 and conducted a time to first event analysis of a composite end point including mortality, readmissions, and emergency department visits. RESULTS: The Intervention group showed higher knowledge scores at discharge and 1 year (P = .05). The risk of noncompliance in Intervention patients varied from 0.78 (95% CI 0.33-1.89) for ACE-I (13% Intervention, 17% Control) to 1.02 (0.49-2.12) for diuretics (23% Intervention, 23% Control). Quality of life improved in both groups over time; the only difference between groups favored the Intervention (Minnesota Living with Heart Failure Questionnaire, P = .04). The composite end point occurred in 67% of control and 60% of Intervention patients (hazard ratio 0.85, 95% CI 0.55-1.30). CONCLUSIONS: An inhospital educational intervention improved knowledge and, possibly, quality of life and may be useful as part of a comprehensive compliance enhancing strategy in patients with HF.
RCT Entities:
BACKGROUND:Patients with heart failure (HF) face challenges complying with multidrug regimens. OBJECTIVES: To examine the impact of a compliance enhancing intervention on medication compliance and morbidity in HF. DESIGN:Patients were randomized to either usual care or an inhospital educational intervention delivered by a multidisciplinary team (Intervention). SETTING: Acute medical and surgical units at a teaching hospital. PATIENTS: One hundred thirty four patients with a clinical diagnosis of HF and a left ventricular ejection fraction of < 40% requiring long-term medical treatment. MAIN OUTCOME MEASURES: A validated HF-specific instrument provided a measure of knowledge. We characterized patients as noncompliant if pharmacy refill data suggested they had taken < or = 0.80 of their medication. We measured quality of life using the Minnesota Living with Heart Failure Questionnaire and the Short Form 36 and conducted a time to first event analysis of a composite end point including mortality, readmissions, and emergency department visits. RESULTS: The Intervention group showed higher knowledge scores at discharge and 1 year (P = .05). The risk of noncompliance in Intervention patients varied from 0.78 (95% CI 0.33-1.89) for ACE-I (13% Intervention, 17% Control) to 1.02 (0.49-2.12) for diuretics (23% Intervention, 23% Control). Quality of life improved in both groups over time; the only difference between groups favored the Intervention (Minnesota Living with Heart Failure Questionnaire, P = .04). The composite end point occurred in 67% of control and 60% of Intervention patients (hazard ratio 0.85, 95% CI 0.55-1.30). CONCLUSIONS: An inhospital educational intervention improved knowledge and, possibly, quality of life and may be useful as part of a comprehensive compliance enhancing strategy in patients with HF.
Authors: Shannon M Dunlay; Jessica M Eveleth; Nilay D Shah; Sheila M McNallan; Véronique L Roger Journal: Mayo Clin Proc Date: 2011-03-09 Impact factor: 7.616
Authors: Robby Nieuwlaat; Nancy Wilczynski; Tamara Navarro; Nicholas Hobson; Rebecca Jeffery; Arun Keepanasseril; Thomas Agoritsas; Niraj Mistry; Alfonso Iorio; Susan Jack; Bhairavi Sivaramalingam; Emma Iserman; Reem A Mustafa; Dawn Jedraszewski; Chris Cotoi; R Brian Haynes Journal: Cochrane Database Syst Rev Date: 2014-11-20
Authors: J Malcom; O Arnold; Jonathan G Howlett; Anique Ducharme; Justin A Ezekowitz; Martin J Gardner; Nadia Giannetti; Haissam Haddad; George A Heckman; Debra Isaac; Philip Jong; Peter Liu; Elizabeth Mann; Robert S McKelvie; Gordon W Moe; Anna M Svendsen; Ross T Tsuyuki; Kelly O'Halloran; Heather J Ross; Errol J Sequeira; Michel White Journal: Can J Cardiol Date: 2008-01 Impact factor: 5.223
Authors: Jia-Rong Wu; Debra K Moser; Marla J De Jong; Mary Kay Rayens; Misook L Chung; Barbara Riegel; Terry A Lennie Journal: Am Heart J Date: 2008-12-24 Impact factor: 4.749