Joanne Simpson1, Colette E Jackson1, Caroline Haig2, Pardeep S Jhund1, Maciej Tomaszewski3,4, Roy S Gardner1, Yannis Tsorlalis1, Mark C Petrie1, John J V McMurray1, Iain B Squire5,6, Pankaj Gupta5,7. 1. Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK. 2. Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow G12 8QQ, UK. 3. Division of Cardiovascular Sciences, Faculty of Biology, Medicine and Health, University of Manchester, AV Hill Building, Upper Brook Street, Manchester M13 9PT, UK. 4. Division of Medicine, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK. 5. Department of Cardiovascular Sciences, University of Leicester, NIHR Biomedical Research Centre, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. 6. National Institute of Health Research Leicester Biomedical Research Unit in Cardiovascular Disease, Glenfield Hospital, Groby Road, Leicester LE3 9QP, UK. 7. Department of Chemical Pathology, University Hospitals of Leicester NHS Trust, Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK.
Abstract
AIMS: None of the existing studies on adherence have directly measured levels of all medications (or their metabolites) in patients with heart failure (HF). METHODS AND RESULTS: We used liquid chromatography-tandem mass spectrometry to measure the presence of prescribed drugs (diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists) in the urine of patients reviewed 4-6 weeks after hospitalization with HF. Patients were unaware that adherence was being assessed. Of the 341 patients studied, 281 (82.4%) were adherent, i.e. had all prescribed drugs of interest detectable in their urine. Conversely, 60 patients (17.6%) were partially or completely non-adherent. Notably, 24 of the 60 were non-adherent to only diuretic therapy and only seven out of all 341 patients studied (2.1%) were completely non-adherent to all prescribed HF drugs. There were no major differences in baseline characteristics between adherent and non-adherent patients. CONCLUSION: Non-adherence, assessed using a single spot urine measurement of drug levels, was confirmed in one of five patients evaluated 4-6 weeks after hospitalization with HF. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: None of the existing studies on adherence have directly measured levels of all medications (or their metabolites) in patients with heart failure (HF). METHODS AND RESULTS: We used liquid chromatography-tandem mass spectrometry to measure the presence of prescribed drugs (diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists) in the urine of patients reviewed 4-6 weeks after hospitalization with HF. Patients were unaware that adherence was being assessed. Of the 341 patients studied, 281 (82.4%) were adherent, i.e. had all prescribed drugs of interest detectable in their urine. Conversely, 60 patients (17.6%) were partially or completely non-adherent. Notably, 24 of the 60 were non-adherent to only diuretic therapy and only seven out of all 341 patients studied (2.1%) were completely non-adherent to all prescribed HF drugs. There were no major differences in baseline characteristics between adherent and non-adherent patients. CONCLUSION: Non-adherence, assessed using a single spot urine measurement of drug levels, was confirmed in one of five patients evaluated 4-6 weeks after hospitalization with HF. Published on behalf of the European Society of Cardiology. All rights reserved.
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