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Non-adherence to heart failure medications predicts clinical outcomes: Assessment in a single spot urine sample by liquid chromatography - tandem mass spectrometry (results of a prospective multicentre study).

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journal contribution
posted on 2021-04-20, 15:33 authored by Pankaj Gupta, Adriaan A Voors, Prashanth Patel, Dan Lane, Stefan D Anker, John GF Cleland, Kenneth Dickstein, Gerasimos Filippatos, CC Lang, Dirk J van Veldhuisen, Marco Metra, Faiez Zannad, Nilesh J Samani, Don JL Jones, Iain B Squire, Leong L Ng
Non-adherence to guideline directed medical therapies in patients with heart
failure (HF) is associated with worsening symptoms, frequent hospitalisations and premature
death. 1Non-adherence also poses risks to patients through unnecessary treatment escalation,
tests (e.g. imaging, laboratory) and invasive interventions (e.g. device therapy, cardiac
transplantation etc.), with significant cost to the economy through avoidable hospital
admissions, resource waste and disease complications. 2, 3
Current estimates of non-adherence to HF medications range from 55 to 60% across cohorts 4
and in these studies, non-adherence was associated with an increased risk of adverse clinical
outcomes including death and/or hospital admissions due to HF. 5-7 A major limitation of
previous studies has been the unreliability, impracticality and lack of specificity of the
methods used to assess non-adherence, such as pill counting, patient self-administered
questionnaires, electronic-monitoring devices and review of prescription claim databases.8-10
The wide range of non-adherence rates reported in HF reflects the current lack of a reliable,
standard test for non-adherence in these patients.4
Given the high rates of non-adherence in patients with heart failure, the difficulties
in assessing non-adherence and the proven benefits of several classes of medicines in heart
failure with reduced left ventricular ejection fraction (HFrEF), there is a need for an objective
tool to assess non-adherence in clinical practice that in turn could lead to an improvement in
adherence and outcomes in this cohort of patients.11
Recently, an objective and robust biochemical test for the presence of
medication in a spot urine or blood sample has become available. 12, 13 14-16 In the
present study, we used biochemical adherence testing in urine from a large group of well -
characterized patients with HFrEF to describe prevalence, clinical characteristics and
outcomes related to non-adherence of HF therapies.


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Department of Cardiovascular Sciences


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European journal of heart failure







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