Assessment of adherence to therapy in comorbid patients

Abstract

Objective. To evaluate adherence to therapy in patients with hypertension (HTN) and atrial fibrillation (AF) in combination with extracardiac comorbid pathology. Design and methods. In an observational cohort study, 884 patients aged 45–65 years with AF (paroxysmal and persistent form) and HTN were observed, in combination with extracardiac comorbid diseases: diabetes mellitus (DM), n = 123; abdominal obesity (AO), n = 171; chronic obstructive pulmonary disease (COPD), n = 137, hypothyroidism, n = 156; thyrotoxicosis, n = 112. The comparison group consisted of 185 patients with AF and HTN, without concomitant extracardiac pathology. Clinical, anthropometric parameters, the Morischi–Green adherence test were evaluated in the work. To assess the social aspects of low adherence, special questionnaires were developed. All statistical calculations were performed using the Rstudio program. Results. Among patients with AF and HTN, 66 % had concomitant extracardiac comorbid pathology, 20 % of them with DM; COPD was detected in 22 % of patients, and AO was observed in 44 % of patients, 6 % patients had thyroid disease. 15,2 % patients were insufficiently adherent (ADH), 37,2 % were not adherent to therapy (NADH), and only 47,8 % respondents were adherent to therapy. The duration of HTN was not a significant motivation for adherence, because the NADH group had a significantly longer duration of arterial hypertension compared with the ADH group (12.3 vs 10.5 years; p < 0.03); patients with the permanent form of AF were more than ADH (p = 0,001), and the adherence did not differ between groups depending on extracardiac diseases. The blockers of the renin-angiotensin-aldosterone system showed the greatest use — up to 66 %, while adherent patients were more likely to take single-pill combination (SPC) of perindopril (SPC indapamide/perindopril and SPC amlodipine/indapamide/perindopril) (p = 0,003; p = 0,01). Based on the analysis, it was found that the presence of a family, higher education, income level, motivation and trust in doctors are significant factors that increase adherence to treatment. Conclusions. The problem of non-commitment has been and remains one of the most complex and difficult to solve. The main reason for low adherence among patients with AF with concomitant extracardiac diseases was polypharmacy, and it is associated with the use of a large number of drugs and a complex treatment regimen. Thus, the limitation of the use of fixed combinations is one of the main reasons for the lack of adherence and needs to be addressed soon.