Mwita Julius Chacha, Joubert Andre, Saidu Hadiza, Sani Mahmoud Umar, Damasceno Albertino, Mocumbi Ana Olga, Sinxadi Phumla, Viljoen Charle Andre, Hoevelmann Julian, Gebreyesus Manna Semere, Denti Paolo, Wasmann Roeland, Maartens Gary, Wiesner Lubbe, Stewart Simon, Davison Beth, Cotter Gad, Sliwa Karen
Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana.
Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa.
Int J Cardiol Cardiovasc Risk Prev. 2023 Sep 16;19:200213. doi: 10.1016/j.ijcrp.2023.200213. eCollection 2023 Dec.
Poor medication adherence leads to poor health outcomes and increased healthcare costs among patients with heart failure (HF). This study aimed to objectively assess medication adherence by measuring carvedilol and enalaprilat plasma concentrations among patients with HF.
The present sub-study of the Safety, Tolerability, and Efficacy of Rapid Optimization, helped by NT-proBNP testing, of Heart Failure therapies (STRONG-HF) study involved adult patients with acute HF admitted in two Mozambican and two Nigerian hospitals who were not optimally treated with oral enalapril and carvedilol. Patients in the high-intensity arm of the TRONG-HF study, and those not meeting the biomarker criteria for persistent congestion, were included in the "frequent visit" (FV) arm. In the FV arm, blood for bioanalysis of plasma enalaprilat or/and carvedilol was drawn at the 2,6,12th week post-discharge. Patients in the usual care arm of STRONG-HF were included in the "standard visit" (SV) arm, which followed the usual local practice with blood sampling in week 12.
The study involved 113 (79 FV and 34 SV) participants with a mean age of 48.6 years and a mean left ventricular (LV) ejection fraction of 33.1%. Theenalaprilat below the lower level of quantification (LLOQ) was documented in 7.7%, 11.9%, and 15.6% of participants in FV during the 2,6 and 12th weeks. Carvedilol concentration below LLOQ was documented in 37%, 30%, and 44.4% of participants in the FV arm during the 2,6 and 12th weeks, respectively. For the SV arm, enalaprilat and carvedilol concentrations below LLOQ in the twelfth week were documented in 37.3% and 42.9% of patients, respectively.
Up to a third of patients using enalapril and carvedilol did not take any medication during the 12 weeks of follow-up. Non adherence was more common in patients who had less follow up, emphasizing the importance of close follow up to adherence. No adherence was also more common in medications know to have more side effects such as carvedilol.
在心力衰竭（HF）患者中，用药依从性差会导致健康状况不佳，并增加医疗成本。本研究旨在通过测量HF患者体内卡维地洛和依那普利拉的血浆浓度来客观评估用药依从性。
本项心力衰竭治疗快速优化的安全性、耐受性和有效性的子研究（STRONG-HF）借助NT-proBNP检测，纳入了在莫桑比克和尼日利亚的两家医院住院的急性HF成年患者，这些患者未接受口服依那普利和卡维地洛的最佳治疗。STRONG-HF研究高强度组的患者以及未达到持续性充血生物标志物标准的患者被纳入“频繁访视”（FV）组。在FV组中，出院后第2、6、12周采集血液用于血浆依那普利拉或/和卡维地洛的生物分析。STRONG-HF常规治疗组的患者被纳入“标准访视”（SV）组，该组按照当地常规做法在第12周进行血液采样。
该研究纳入了113名参与者（79名FV组和34名SV组），平均年龄为48.6岁，平均左心室（LV）射血分数为33.1%。在FV组中，第2、6和12周分别有7.7%、11.9%和15.6%的参与者的依那普利拉浓度低于定量下限（LLOQ）。在FV组中，第2、6和12周分别有37%、30%和44.4%的参与者的卡维地洛浓度低于LLOQ。对于SV组，第12周依那普利拉和卡维地洛浓度低于LLOQ的患者分别为37.3%和42.9%。
在随访的12周内，使用依那普利和卡维地洛的患者中，多达三分之一的患者未服用任何药物。依从性差在随访较少的患者中更为常见，强调了密切随访对依从性的重要性。在已知有更多副作用的药物（如卡维地洛）中，不依从也更为常见。
