慢性心力衰竭患者对特定药物类别的服药依从性
Medication adherence to specific drug classes in chronic heart failure.
作者信息
Viana Marta, Laszczynska Olga, Mendes Sandra, Friões Fernando, Lourenço Patrícia, Bettencourt Paulo, Lunet Nuno, Azevedo Ana
机构信息
Instituto de Saúde Pública da Universidade do Porto, Rua das Taipas nº 135, 4050-600 Porto, Portugal.
出版信息
J Manag Care Spec Pharm. 2014 Oct;20(10):1018-26. doi: 10.18553/jmcp.2014.20.10.1018.
BACKGROUND
Adherence to medication is crucial to improve clinical outcomes in patients with heart failure (HF). However, at least 1 out of 4 patients is nonadherent to his or her medication. Several studies have quantified medication adherence in HF patients, monitoring only 1 drug with the Medication Event Monitoring System (MEMS). Some authors have argued that monitoring 1 drug reflects the whole adherence behavior, although there is some evidence of important differences in adherence to distinct drug classes. Furthermore, medication characteristics could be a relevant predictor of adherence, and different drugs could pose different barriers to patients.
OBJECTIVES
To (a) quantify medication adherence to angiotensin-converting enzyme inhibitors (ACEI), beta blockers, and loop diuretics and (b) compare the agreement in adherence among drug classes in chronic HF.
METHODS
Medication adherence to 3 different drugs was monitored using MEMS in 63 patients (81% male, mean age 63.5 years). Medication adherence was measured as the percentage of prescribed doses effectively taken. Patients were considered to be adherent when at least 88% of prescribed doses were taken. Adherence agreement between drug classes was analyzed with Bland-Altman plots and Kappa coefficients.
RESULTS
The mean adherence was 97.3% for ACEI, 97.2% for beta blockers, and 96.0% for loop diuretics. Individual patients did not adhere equally to all drug classes, with differences within the same patient ranging from -35% to 33%. The proportion of patients classified as adherent was 77.8% to ACEI, 69.8% to beta blockers, and 69.8% to loop diuretics. The agreement between each of 2 drugs regarding adherence was substantial (beta blocker vs. ACEI: K = 0.72; beta blocker vs. diuretic: K = 0.62; ACEI vs. diuretic: K = 0.72). If patients were classified as adherent and nonadherent based only on 1 drug, 20% of patients would be misclassified regarding the other drugs.
CONCLUSIONS
Patients can adhere differently to medication used in HF treatment, with lowest adherence to loop diuretic and beta blockers and highest adherence to ACEI. Studies measuring medication adherence should always specify the drug class being analyzed and should not mix different drug classes to generalize about adherence behavior.
背景
坚持服药对于改善心力衰竭（HF）患者的临床结局至关重要。然而，至少四分之一的患者不坚持服药。多项研究已对HF患者的服药依从性进行了量化，仅使用药物事件监测系统（MEMS）监测一种药物。一些作者认为监测一种药物就能反映整体的依从行为，尽管有证据表明不同药物类别的依从性存在重要差异。此外，药物特性可能是依从性的一个相关预测因素，不同药物可能给患者带来不同的障碍。
目的
（a）量化血管紧张素转换酶抑制剂（ACEI）、β受体阻滞剂和襻利尿剂的服药依从性，（b）比较慢性HF中不同药物类别之间依从性的一致性。
方法
使用MEMS对63例患者（81%为男性，平均年龄63.5岁）的3种不同药物的服药依从性进行监测。服药依从性以有效服用的规定剂量百分比来衡量。当服用至少88%的规定剂量时，患者被视为依从。使用Bland-Altman图和Kappa系数分析不同药物类别之间的依从性一致性。
结果
ACEI的平均依从性为97.3%，β受体阻滞剂为97.2%，襻利尿剂为96.0%。个体患者对所有药物类别的依从性并不相同，同一患者内的差异范围为-35%至33%。被归类为依从的患者比例，ACEI为77.8%，β受体阻滞剂为69.8%，襻利尿剂为69.8%。两种药物之间在依从性方面的一致性较高（β受体阻滞剂与ACEI：K = 0.72；β受体阻滞剂与利尿剂：K = 0.62；ACEI与利尿剂：K = 0.72）。如果仅根据一种药物将患者分类为依从和不依从，那么20%的患者在其他药物方面会被错误分类。
结论
患者对HF治疗中使用的药物的依从性可能不同，对襻利尿剂和β受体阻滞剂的依从性最低，对ACEI的依从性最高。测量服药依从性的研究应始终明确所分析的药物类别，不应混合不同药物类别来概括依从行为。
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