# A Randomized Controlled Trial Studying the Effect of Medication Adherence Tools in Patients With Heart Failure

## TL;DR

This study shows that using medication adherence tools improves medication compliance and quality of life in heart failure patients.

## Contribution

The study introduces a novel integrated intervention combining medication adherence tools with health education for heart failure patients.

## Key findings

- Medication adherence significantly improved in the intervention group using adherence tools.
- Quality of life and physical ability also improved in the intervention group.
- Non-adherence was most common with diuretics, and poor memory was the leading cause.

## Abstract

Background

Heart failure significantly contributes to the global increase in morbidity and mortality. In managing such chronic conditions, medication adherence plays a critical role in patient outcomes. Given the extensive consequences associated with non-adherence in heart failure, it is crucial to implement focused interventions that support and enhance compliance of patients in taking their prescribed medications. Therefore, this study aims to determine the effect of medication adherence tools (MAT) as an intervention to improve medication adherence and functional capacity in patients with heart failure.

Methods

In a prospective, open-label, randomized controlled study, 200 patients with heart failure were recruited, with 100 in the control group who received the standard prescribed drugs and 100 in the intervention group who received the intervention in addition to the standard prescribed drugs. A multidrug ABCD drug regimen was used for better understanding and distribution of medicines The four classes of drugs included (A) angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers/angiotensin receptor neprilysin inhibitor, (B) beta-blockers/funny channel blocker (ivabradine), (C) companion drugs (digoxin, hydralazine+isosorbide dinitrate, intravenous iron, statins, oral anticoagulants/antiplatelets, antiarrhythmics, etc.), and (D) diuretics/mineralocorticoid receptor antagonists. The intervention included the ABCD drug regimen as a pharmacological approach, health education, and MAT, such as the Hriday Card, Dhadkan 2 mobile application, and labeled separate zip locks for dispensing the drugs separately as per the ABCD drug regimen. Medication adherence was assessed through the Morisky-Green-Levine (MGL) adherence scale, and quality of life assessment was done using a Likert scale. Further, physical ability was assessed by the capacity to climb floors, ability to do routine household work, and capability to walk 500 m without taking a rest.

Results

Based on the MGL adherence scale, 42 (21%) patients showed high, 132 (66%) showed medium, and 26 (13%) showed low adherence at baseline, including both the study groups. The reasons for non-adherence were found to be poor memory in 48 (24%), travelling outstation in 42 (21%), ran out of medicines in 32 (16%), adverse effects of medicines in 26 (13%), felt worse while taking medicine in 14 (7%), felt better so stopped taking medicine in 14 (7%), less affordability in six (3%), and other than these reasons in 18 (9%) of the patients. Only 40 (20%) patients demonstrated non-adherence to at least one specific class of medication, with non-adherence being maximum with diuretics. Significant improvement in medication adherence was observed in the intervention group in terms of improvement in the MGL score. There was also a significant improvement in the quality of life and the physical ability in the patients of the intervention group.

Conclusion

The findings indicate a significant occurrence of medication non-adherence among patients with heart failure within the studied population. Implementing a comprehensive, integrated intervention strategy that includes MAT led to enhanced adherence to the prescribed medications, along with notable improvements in patients’ quality of life and physical functioning. Consequently, incorporating MAT as an adjunctive measure could be recommended as an additional step toward improved outcomes in the management of patients with heart failure.