CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 2, March/April 2010
Cardiovascular Topics
86
AFRICA
Medication adherence, self-care behaviour and
knowledge on heart failure in urban South Africa:
the Heart of Soweto study
VERENA RUF, SIMON STEWART, SANDRA PRETORIUS, MAUREEN KUBHEKA, CHRISTINE
LAUTENSCHLÄGER, PETER PRESEK, KAREN SLIWA
Summary
Background:
There is a paucity of data on treatment adher-
ence in patients with chronic heart failure (CHF) in Africa.
Methods:
We examined the pattern of treatment adherence,
self-care behaviour and treatment knowledge in 200 consecu-
tive patients with CHF attending the Chris Hani Baragwanath
Hospital, Soweto, South Africa via a combination of ques-
tionnaire (100%,
n
=
200) and pill count (41%,
n
=
82).
Results:
Mean age was 56
±
14 years, 157 were black African
(79%) and 109 (55%) were male. CHF-specific treatment
included loop diuretics (93%), beta-blockers (84%), ACE
inhibitors (74%), spironolactone (64%) and cardiac glycosides
(24%);meannumberofmedicationswas6
±
2.Overall,71%(58
of 82) adhered to their prescribed CHF regimen and individu-
al medication adherence ranged from 64 to 79%. Behavioural
adherence varied from 2.5 to 98%. Patient treatment knowl-
edge was poor; 56% could not name medication effects or
side effects. However, an average knowledge score of 69%
was achieved on 10 questions concerning CHF management.
Conclusion:
As in other regions of the world, non-adherence
to complex CHF treatment is a substantial problem in
Soweto. Our data confirm the need for a dedicated CHF
management programme to optimise CHF-related outcomes
in a low-resource environment.
Keywords:
medication adherence, self-care behaviour, know-
ledge, heart failure, Africa
Submitted 12/3/09, accepted 14/8/09
Cardiovasc J Afr
2010;
21
: 86–92
Although the population burden and individual impact of chronic
heart failure (CHF) has been well described in the western
world,
1
it has been less well described on the African continent.
2,3
Significantly, CHF represents an emerging problem in low- to
middle-income countries in sub-Saharan Africa undergoing
epidemiological transition.
3
For example, CHF is already an
important cause of morbidity and mortality in black South
Africans and it is conceivable that the incidence of CHF will
increase over time.
4
In addition to the need for a series of studies
in Africa that parallel the detailed documentation of the epidemic
of heart failure in the western world,
5
we also need to better
understand the individual experiences of those affected by heart
failure in African communities. In this context, one of the key
issues that determine individual outcomes is patient knowledge
and adherence to prescribed gold-standard, non-pharmacological
and pharmacological treatments.
6
Results from high-income countries have shown that poor
adherence to medical recommendations remains a substantial
problem among people with CHF who must follow a multi-
component treatment regimen that includes medications, dietary
restrictions and exercise recommendations.
7
Overall, it has been
estimated that between one-third and one-half of all patients
with chronic heart conditions have difficulty adhering to their
prescribed medication regimen in the western world, contrib-
uting to impaired quality of life, high healthcare costs linked
to increasing rates of hospital re-admissions and out-patient
hospital care, in addition to premature mortality.
8
Importantly,
increased CHF-related knowledge is associated with better treat-
ment adherence.
9
However, despite its potential clinical impor-
tance (there is no reason to suspect African patients are immune
to this problem), there is a paucity of data on treatment adher-
ence in patients with heart disease in the African context.
10-12
Methods
It is within the above context that we examined patterns of adher-
ence to prescribed pharmacological and non-pharmacological
therapy in a large cohort of black African patients in Soweto,
diagnosed with CHF. We also examined their understanding of
Soweto Cardiovascular Research Unit, Department of
Cardiology, Chris Hani-Baragwanath Hospital, Soweto,
Johannesburg, South Africa
VERENA RUF, MD
SIMON STEWART, PhD, FCSANZ, NFESC, FAHA
SANDRA PRETORIUS, RD (SA)
MAUREEN KUBHEKA, B Curr
KAREN SLIWA, MD, PhD,
Baker Heart Research Institute, Melbourne, Australia
SIMON STEWART, PhD, FCSANZ, NFESC, FAHA
Institute for Medical Epidemiology, Biometrics and Computer
Science, Martin-Luther University Halle-Wittenberg, Halle
(Saale), Germany
CHRISTINE LAUTENSCHLÄGER, PhD
Institute of Pharmacology, Division of Clinical Pharma-
cology, Martin-Luther University Halle-Wittenberg, Halle
(Saale), Germany
VERENA RUF, MD
PETER PRESEK, MD
