Evaluation of drug therapy problems, medication adherence and treatment satisfaction among heart failure patients on follow-up at a tertiary care hospital in Ethiopia

Abstract

Background: Drug therapy problems (DTPs) are major concerns of healthcare and have been identified to contribute to negative clinical outcomes. The occurrence of DTPs in heart failure patients is associated with worsening of outcomes. The aim of this study was to assess DTPs, associated factors and patient satisfaction among ambulatory heart failure patients at Tikur Anbessa Specialized Hospital (TASH).

Methods: A hospital based prospective cross-sectional study was conducted on 423 heart failure patients on follow up at TASH. Data was collected through patient interview and chart review. Descriptive statistics, binary and multiple logistic regressions were used for analyses and P < 0.05 was used to declare association.

Results: Majority of the patients were in NYHA class III (55.6%) and 66% of them had preserved systolic function. DTPs were identified in 291(68.8%) patients, with an average number of 2.51±1.07.per patient. The most common DTPs were drug interaction (27.3%) followed by noncompliance (26.2%), and ineffective drug use (13.7%). β blockers were the most frequent drug class involved in DTPs followed by angiotensin converting enzyme inhibitors. The global satisfaction was 78% and the overall mean score of treatment satisfaction was 60.5% (SD, 10.5).

Conclusion: Prevalence of DTPs as well as non-adherence among heart failure patients on follow up is relatively high. Detection and prevention of DTPs along with identifying patients at risk can save lives, help to adopt efficient strategies to closely monitor patients at risk, enhance patient's quality of life and optimize healthcare costs.

Fig 1. Common valve lesions observed among heart failure patients attending at the cardiac clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia June—August, 2017.

AR: Aortic Regurgitation, AS: Aortic Stenosis, MR: Mitral Regurgitation, MS: Mitral Stenosis, TR: Tricuspid Regurgitation.

Fig 2. Frequently prescribed drug class in heart failure patients attending at the cardiac clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia June-August, 2017.

Anti arrhythmic, antianginal agent, antithyroid, antiTB, HAART, Iron salt, NSAIDs, xanthine oxidase inhibitor, tricyclic antidepressant; ACIEs: angiotensin converting enzyme inhibitors, ARBs: angiotensin receptor blockers, CCBs: calcium channel blockers, OHA: oral hypoglycemic agents.

Fig 3. Drug classes involved in specific type of drug therapy problems among heart failure patients attending at the cardiac clinic of Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia June—August, 2017.