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Objectively measured medication adherence using assays for carvedilol and enalaprilat in patients with heart failure in Mozambique and Nigeria

Authors :
Julius Chacha Mwita
Andre Joubert
Hadiza Saidu
Mahmoud Umar Sani
Albertino Damasceno
Ana Olga Mocumbi
Phumla Sinxadi
Charle Andre Viljoen
Julian Hoevelmann
Manna Semere Gebreyesus
Paolo Denti
Roeland Wasmann
Gary Maartens
Lubbe Wiesner
Simon Stewart
Beth Davison
Gad Cotter
Karen Sliwa
Source :
International Journal of Cardiology. Cardiovascular Risk and Prevention, Vol 19, Iss , Pp 200213- (2023)
Publication Year :
2023
Publisher :
Elsevier, 2023.

Abstract

Background: Poor medication adherence leads to poor health outcomes and increased healthcare costs among patients with heart failure (HF). This study aimed to objectively assess medication adherence by measuring carvedilol and enalaprilat plasma concentrations among patients with HF. Methods: The present sub-study of the Safety, Tolerability, and Efficacy of Rapid Optimization, helped by NT-proBNP testing, of Heart Failure therapies (STRONG-HF) study involved adult patients with acute HF admitted in two Mozambican and two Nigerian hospitals who were not optimally treated with oral enalapril and carvedilol. Patients in the high-intensity arm of the STRONG-HF study, and those not meeting the biomarker criteria for persistent congestion, were included in the “frequent visit” (FV) arm. In the FV arm, blood for bioanalysis of plasma enalaprilat or/and carvedilol was drawn at the 2,6,12th week post-discharge. Patients in the usual care arm of STRONG-HF were included in the “standard visit” (SV) arm, which followed the usual local practice with blood sampling in week 12. Results: The study involved 113 (79 FV and 34 SV) participants with a mean age of 48.6 years and a mean left ventricular (LV) ejection fraction of 33.1%. Theenalaprilat below the lower level of quantification (LLOQ) was documented in 7.7%, 11.9%, and 15.6% of participants in FV during the 2,6 and 12th weeks. Carvedilol concentration below LLOQ was documented in 37%, 30%, and 44.4% of participants in the FV arm during the 2,6 and 12th weeks, respectively. For the SV arm, enalaprilat and carvedilol concentrations below LLOQ in the twelfth week were documented in 37.3% and 42.9% of patients, respectively. Conclusion: Up to a third of patients using enalapril and carvedilol did not take any medication during the 12 weeks of follow-up. Non adherence was more common in patients who had less follow up, emphasizing the importance of close follow up to adherence. No adherence was also more common in medications know to have more side effects such as carvedilol.

Details

Language :
English
ISSN :
27724875
Volume :
19
Issue :
200213-
Database :
Directory of Open Access Journals
Journal :
International Journal of Cardiology. Cardiovascular Risk and Prevention
Publication Type :
Academic Journal
Accession number :
edsdoj.7e1e5578af3e474d9a8ffc2888ffa703
Document Type :
article
Full Text :
https://doi.org/10.1016/j.ijcrp.2023.200213