Medication Non-Adherence Common in Emergency Cases

Patients suffering from heart failure typically receive a combination of four different classes of medications according to current clinical guidelines. These drugs are intended to manage symptoms and slow disease progression. Many of these patients, who are mostly older adults, often take additional medications, leading to a significant pill burden.

Researchers from the University Hospital of Saarland and the Cardiology Clinic in Basel conducted a study to assess medication adherence among patients admitted to the emergency department in Homburg due to acutely decompensated heart failure. The study involved 100 patients (61% female, average age 77.9 years), who underwent screening of blood and urine samples for the presence of active ingredients or metabolites from their heart failure medications. Additionally, the patients were asked about their adherence to prescribed treatments. The findings were published in the European Journal of Heart Failure.

The results revealed that only 39% of the participants had detectable metabolites of all prescribed heart failure medications in their urine. A similar percentage of patients were found to be partially adherent, missing one of their medications. The remaining 22% were classified as non-adherent, as they lacked two or more prescribed drugs.

The analysis indicated that non-adherent patients had a higher number of heart failure medications on their treatment plans and a significantly greater overall pill burden compared to those who were at least partially adherent. However, only 23% to 45% of patients received a treatment regimen that aligned with clinical guidelines, suggesting that some patients were not prescribed sufficient medications. Additionally, around half of the study participants reported using over-the-counter medications.

Interestingly, the non-adherent group tended to be younger and exhibited better cognitive function. The likelihood of adherence increased when patients received medication management support from caregivers or pharmacists.

It was not surprising that patients' self-reported adherence did not consistently align with toxicological analyses. This discrepancy prompted the authors to caution against solely relying on patients' accounts of their medication intake. Overall, they assessed the adherence levels among the admitted patients as low.

The study concluded that non-adherence significantly contributes to the worsening of heart failure, potentially leading to hospitalizations. Future research should focus on strategies to enhance medication adherence, including simplifying treatment regimens, implementing third-party medication management via pharmacies, and developing structured adherence programs.