Institute of Cardiovascular and Medical Sciences, University of Glasgow, British Heart Foundation Glasgow Cardiovascular Research Centre, 126 University Place, Glasgow G12 8TA, UK.
Robertson Centre for Biostatistics, Boyd Orr Building, University of Glasgow, Glasgow G12 8QQ, UK.
Eur Heart J Cardiovasc Pharmacother. 2021 Jul 23;7(4):296-301. doi: 10.1093/ehjcvp/pvaa071.
None of the existing studies on adherence have directly measured levels of all medications (or their metabolites) in patients with heart failure (HF).
We used liquid chromatography-tandem mass spectrometry to measure the presence of prescribed drugs (diuretics, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta-blockers, and mineralocorticoid receptor antagonists) in the urine of patients reviewed 4-6 weeks after hospitalization with HF. Patients were unaware that adherence was being assessed. Of the 341 patients studied, 281 (82.4%) were adherent, i.e. had all prescribed drugs of interest detectable in their urine. Conversely, 60 patients (17.6%) were partially or completely non-adherent. Notably, 24 of the 60 were non-adherent to only diuretic therapy and only seven out of all 341 patients studied (2.1%) were completely non-adherent to all prescribed HF drugs. There were no major differences in baseline characteristics between adherent and non-adherent patients.
Non-adherence, assessed using a single spot urine measurement of drug levels, was confirmed in one of five patients evaluated 4-6 weeks after hospitalization with HF.
目前关于依从性的研究均未直接测量心力衰竭（HF）患者所有药物（或其代谢物）的水平。
我们使用液相色谱-串联质谱法测量了住院 4-6 周后 HF 患者尿液中规定药物（利尿剂、血管紧张素转换酶抑制剂、血管紧张素受体阻滞剂、β受体阻滞剂和盐皮质激素受体拮抗剂）的存在情况。患者不知道正在评估依从性。在研究的 341 名患者中，281 名（82.4%）患者依从性良好，即尿液中可检测到所有感兴趣的规定药物。相反，60 名患者（17.6%）部分或完全不依从。值得注意的是，60 名患者中有 24 名仅不依从利尿剂治疗，而在所有 341 名研究患者中，仅有 7 名（2.1%）完全不依从所有规定的 HF 药物。依从性良好和不依从性良好的患者在基线特征方面没有显著差异。
使用住院后 4-6 周单次尿液药物水平测量评估的不依从性，在评估的 5 名 HF 患者中确认了 1 名患者存在。
