Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients

Bradi B Granger, Inger Ekman, Adrian F Hernandez, Tenita Sawyer, Margaret T Bowers, Tracy A DeWald, Yanfang Zhao, Janet Levy, Hayden B Bosworth, Bradi B Granger, Inger Ekman, Adrian F Hernandez, Tenita Sawyer, Margaret T Bowers, Tracy A DeWald, Yanfang Zhao, Janet Levy, Hayden B Bosworth

Abstract

Background: Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF.

Methods: Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n = 44), a nurse conducted self-management training before discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom response plan. The attention control group (n = 42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point.

Results: Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio 3.92, t = 3.51, P = .0007).

Conclusions: A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.

Trial registration: ClinicalTrials.gov NCT02258516.

Copyright © 2015 Elsevier Inc. All rights reserved.

Figures

Figure 1
Figure 1
CHIME 3-M randomized design.
Figure 2
Figure 2
Medication adherence by nurse-assessed pill counts over time.
Figure 3
Figure 3
Medication adherence by Morisky Medication Adherence Scale (MMAS 8-item) scores over time.
Figure 4
Figure 4
Belief in Medications Questionnaire trends over time.

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