Abstract 1115: Medication Complexity in Heart Failure
Background and purpose: Heart failure (HF) patients have poor medication adherence due to multiple medications and comorbid self care regimens. A better understanding of comprehensive medication-taking behaviors and associated problems encountered by HF patients may illuminate strategies for improving adherence. This pilot project examined complexity in medication taking behavior in HF patients.
Methods: Participants were 49 HF patients, NYHA Classes II and III, mean age 62 years, who were 67% female, 55% African American, 33% living alone, and 94% having completed high school. Demographic and clinical factors (comorbidities, hospitalizations, length of time with HF, NYHA class) and medications were obtained from self-report or chart review. A study specific questionnaire on medication complexity (including items on frequency, special instructions and behaviors required related to medications, and difficulties encountered) was developed, reviewed by experts for face validity, and completed by participants.
Results: Median duration of HF was 7 years (range 1.5 to 17 years); 24% had diabetes, and 94% had ≥2 comorbidities. Participants took a mean of 11.8±4.6 (range 4 –26) different medications daily. Medication or dose adjustments had occurred for 55% in the previous 3 months, and 43% reported use of multiples names for the same medicines when discussed by providers. Medicines were taken once, twice, and three or more times per day by 51%, 26%, and 20%, respectively. Forty-three percent had to perform behaviors specifically required for taking their medicines (e.g., take with food, break in half, refrigerate, weigh self, separate doses, take other medications for side effects). Refill of prescriptions were required at varying times (30 days, 60 days, etc) within an individual’s regimen in 64% of the participants.
Conclusions: HF Patients are prescribed overly complex medication regimens by multiple providers. Providers should evaluate the overall regimen of medications and simplify schedule, dosing, and consistency. Pharmacy and nursing review of the total prescribed medications may result in streamlining required medication taking behaviors and should be tested for effects on reducing burden and improving adherence.