+1 (629)348-3199Medication adherence pattern, associated factors and outcomes among hospitalized heart failure patients in a tertiary hospital in Tanzania: A prospective cohort study
29th International Conference on Nursing Education and Research
December 05-06, 2019 | Dubai, UAE
Jalack Millinga, Pedro Pallangyo, Lucia Kabeya, Naairah R. Hemed, Zabella Seif, Happiness J. Swai, Smita Bhalia,Francis Fredrick, Mohamed Janabi, Stephen Humphrey and Jalack Millinga
Jakaya Kikwete Cardiac Institute, Tanzania
Scientific Tracks Abstracts : J Intensive Crit Care Nurs
Abstract:
Background: Management of heart failure is complex
and multifaceted but adherence to medications remains
the cornerstone of preventing avoidable readmissions,
premature deaths and unnecessary healthcare expenses.
Despite of evidence-based efficacy on anti-failure drugs, poor
adherence is pervasive and remains a significant barrier to
improving clinical outcomes in heart failure population.
Methods: We enrolled 459 patients with established diagnosis
of heart failure. Sociodemographic, clinical, laboratory and
echocardiographic data were gathered using a structured
questionnaire during the hospital admission of enrollment.
Medication adherence was assessed using the 8-item
Morisky Medication Adherence Scale (MMAS-8). The primary
outcome measures were rehospitalization and mortality at
180-days. Linear logistic regression analyses were used to
assess for factors associated with adherence and predictors of
rehospitalization. Based on their adherence status, participants
were compared with respect to survival using Cox proportionalhazards
regression model. All tests were 2-sided and p<0.05
was used to denote statistical significance.
Results: The mean age was 46.4 years and participants
aged ≤50 years constituted 55.4% of the cohort. There was
a female predominance (56.5%), 67.5% resided in urban
areas and 74.2% had primary education. About 22% of all
participants had health insurance. Of the 419 participants
eligible for assessment of medication adherence, 313 (74.7%)
had poor adherence and 106 (25.3%) had good adherence.
Possession of a health insurance was found to be the
strongest associated factor for adherence (OR 8.7, 95% CI 4.7-
16.0, P <0.001). During follow-up, rehospitalization rates were
32.8%, 48.1% and 53.0% at 30, 90 and 180 days respectively.
Participants with poor adherence displayed a 70% increased
risk for rehospitalization compared to their counterparts with
good adherence (RR 1.7, 95% CI 1.2-2.9, p = 0.04). Overall,
177 (42.2%) patients survived the 180-days of follow-up. Poor
adherence was found to be the strongest predictor of early
mortality (HR 2.5, 95% CI 1.3-4.6, p<0.01).
Conclusion: Poor medication adherence in patients with
heart failure is associated with increased readmissions and
mortality. In view of this, deliberate efforts to assess and
improve adherence should be incorporated and become
an integral part of daily patient management. Furthermore,
strategies to increase health insurance acquisition are
fundamental to improve adherence especially among persons
living in resource-poor settings.
Biography:
Jalack millinga is a cardiovascular critical care nurse at Jakaya Kikwete cardiac institute, Dar es salaam,Tanzania. Aside from her clinical passion, she has passion with clinical research. Her main research interests are heart failure, medication adherence and critical care. She aspires to motivate and cultivate the culture of research among other tanzanian nurses through her ongoing research activities.
E-mail: jalackmillinga2@gmail.com
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