Abstract 12212: A Theory-Based Intervention Improves Medication Adherence and Outcomes in Patients with Heart Failure
Background: Nonadherence to heart failure (HF) medications contributes to worse outcomes, yet there are few successful interventions that enhance adherence in HF.
Objective: The purpose was to determine whether a counseling intervention provided to HF patients (pts) improved medication adherence (MA) and cardiac event-free survival.
Methods: A randomized controlled trial was conducted in 61 HF pts. The intervention was based on the Theory of Planned Behavior (TPB) and included feedback of personal medication-taking behavior using the Medication Event Monitoring System (MEMS). Pts were assigned to one of 3 groups: 1) theory-based intervention plus MEMS feedback (PLUS), 2) theory-based intervention only (LITE), or 3) usual care control group. Pts assigned to either of the 2 intervention groups (PLUS or LITE) received 2 counseling sessions with booster phone calls every 2 weeks over 2 months. MEMS was used to measure MA for 9 months and provide feedback to pts in PLUS group only. Pts were followed for 9 months for event-free survival. Repeated measures analysis of variance and survival analysis were used to determine the effect of intervention.
Results: The PLUS and LITE groups did not differ on MA or event-free survival, and thus their data were combined. Pts in both intervention groups demonstrated better adherence across time compared to the control group (p = .027). Event-free survival was better for the pts in both intervention groups than those in control group (Figure). In Cox regression, pts in either intervention groups had a longer event-free survival compared to the control group before and after controlling age, financial status, ejection fraction, NYHA, angiotensin-converting enzyme inhibitor use, and beta-blocker use (p = .028 & p = .047, respectively).
Conclusion: Use of an intervention based on the TPB improves medication adherence and subsequent outcomes in pts with HF. Feedback of actual medication adherence may not be necessary to achieve better outcomes.
- © 2010 by American Heart Association, Inc.