Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA.
Mayo Clin Proc. 2011 Apr;86(4):273-81. doi: 10.4065/mcp.2010.0732. Epub 2011 Mar 9.
To determine medication use and adherence among community-dwelling patients with heart failure (HF).
Residents of Olmsted County, Minnesota, with HF were recruited from October 10, 2007, through February 25, 2009. Pharmacy records were obtained for the 6 months after enrollment. Medication adherence was measured by the proportion of days covered (PDC). A PDC of less than 80% was classified as poor adherence. Factors associated with medication adherence were investigated.
Among the 209 study patients with HF, 123 (59%) were male, and the mean ± SD age was 73.7 ± 13.5 years. The median (interquartile range) number of unique medications filled during the 6-month study period was 11 (8-17). Patients with a documented medication allergy were excluded from eligibility for medication use within that medication class. Most patients received conventional HF therapy: 70% (147/209) were treated with β-blockers and 75% (149/200) with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers. Most patients (62%; 127/205) also took statins. After exclusion of patients with missing dosage information, the proportion of those with poor adherence was 19% (27/140), 19% (28/144), and 13% (16/121) for β-blockers, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers, and statins, respectively. Self-reported data indicated that those with poor adherence experienced more cost-related medication issues. For example, those who adhered poorly to statin therapy more frequently reported stopping a prescription because of cost than those with good adherence (46% vs 6%; P < .001), skipping doses to save money (23% vs 3%; P = .03), and not filling a new prescription because of cost (46% vs 6%; P < .001).
Community-dwelling patients with HF take a large number of medications. Medication adherence was suboptimal in many patients, often because of cost.
确定社区心力衰竭（HF）患者的药物使用和依从性。
2007 年 10 月 10 日至 2009 年 2 月 25 日，从明尼苏达州奥姆斯特德县招募了 HF 患者。在入组后 6 个月内获得了他们的药房记录。通过覆盖天数比例（PDC）来衡量药物依从性。PDC 小于 80%被归类为依从性差。研究了与药物依从性相关的因素。
在 209 名 HF 研究患者中，有 123 名（59%）为男性，平均年龄（标准差）为 73.7 ± 13.5 岁。在 6 个月的研究期间，中位数（四分位距）填写的独特药物数量为 11（8-17）。因药物过敏而被排除在该药物类别的用药资格之外的患者。大多数患者接受了常规 HF 治疗：70%（147/209）接受了β受体阻滞剂治疗，75%（149/200）接受了血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂治疗。大多数患者（62%；127/205）还服用了他汀类药物。在排除了剂量信息缺失的患者后，β受体阻滞剂、血管紧张素转换酶抑制剂或血管紧张素 II 受体阻滞剂和他汀类药物的依从性差的比例分别为 19%（27/140）、19%（28/144）和 13%（16/121）。自我报告的数据表明，依从性差的患者经历了更多与药物费用相关的问题。例如，他汀类药物治疗依从性差的患者更频繁地报告因费用而停止处方（46% vs 6%；P <.001）、为省钱而减少剂量（23% vs 3%；P =.03）以及因费用而未开新处方（46% vs 6%；P <.001）。
社区心力衰竭患者服用大量药物。许多患者的药物依从性不理想，通常是因为费用问题。
