Medication adherence, self-care behaviour and knowledge on heart failure in urban South Africa: the Heart of Soweto study

Abstract

Background: There is a paucity of data on treatment adherence in patients with chronic heart failure (CHF) in Africa.

Methods: We examined the pattern of treatment adherence, self-care behaviour and treatment knowledge in 200 consecutive patients with CHF attending the Chris Hani Baragwanath Hospital, Soweto, South Africa via a combination of questionnaire (100%, n = 200) and pill count (41%, n = 82).

Results: Mean age was 56 +/- 14 years, 157 were black African (79%) and 109 (55%) were male. CHF-specific treatment included loop diuretics (93%), beta-blockers (84%), ACE inhibitors (74%), spironolactone (64%) and cardiac glycosides (24%); mean number of medications was 6 +/- 2. Overall, 71% (58 of 82) adhered to their prescribed CHF regimen and individual medication adherence ranged from 64 to 79%. Behavioural adherence varied from 2.5 to 98%. Patient treatment knowledge was poor; 56% could not name medication effects or side effects. However, an average knowledge score of 69% was achieved on 10 questions concerning CHF management.

Conclusion: As in other regions of the world, non-adherence to complex CHF treatment is a substantial problem in Soweto. Our data confirm the need for a dedicated CHF management programme to optimise CHF-related outcomes in a low-resource environment.

Fig. 1.

Aetiology of CHF in the total study population.

Fig. 2.

Reported adherence to self-care behaviour. Appointment adherence was achieved when being present at ≥ 75% of assigned appointments consisting of quarterly check-ups and monthly medication refills at the hospital pharmacy. Medication adherence represents the number of patients who took ≥ 75% of their medication, determined through pill counts. Adhering to fruit intake meant five servings of fruit per day and adherence in fluid intake was accomplished when drinking less than two litres per day. Regular physical activity was achieved when study participants walked moderately for 20 to 30 minutes three to four times a week. A moderate alcohol intake meant one beer or one to two glasses of wine per day.

Fig. 3.

Adherence to individual medication. n = number of conducted pill counts

Fig. 4.

Percentage of health education given on various aspects of self-care behaviour and heart failure. Health education on daily weight monitoring was given if a patient knew about this way of HF management. Health education give on a healthy diet was accomplished when a patient was informed on the positive effect of a diet rich in vegetables and fruits. Health education on fluid intake was given if a patient knew that there is a restriction of < two litres per day. Health education on alcohol restriction meant informing patients to aim for a moderate alcohol intake (one beer or one to two glasses of wine per day). Health education on physical activity was provided to those with stable CHF and smokers were told about the benefits of refraining from smoking. Information on HF consisted of information about the nature of the syndrome.