CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 2, March/April 2010
AFRICA
89
ence to the appointment given for the pill count with only 82
of 200 patients returning (41%). These pill counts revealed that
71% were clearly compliant and 22% non-compliant with their
overall prescribed HF regimen (a pill count was not possible in
7% of this subgroup of participants).
Fig. 3 shows that the highest adherence rates were for ACE
inhibitors and spironolactone compared to the lowest for loop
diuretics. Participants reported skipping their loop diuretic
(furosemide) most often, with forgetfulness and avoidance of
side effects being the most common reasons for non-adherence
overall.
Determinants for treatment adherence
There were no statistically significant factors linked to treatment
non-adherence on the basis of multiple logistic regression analy-
sis. However, those participants reporting less than three of the
symptoms commonly found in patients with CHF were 4.5-fold
(95% CI: 0.95–21.7;
p
=
0.058) more likely to be designated as
compliant, demonstrating the importance of treatment for symp-
tom control and likely clinical benefit of prescribed treatment.
At the same time, men tended to be more compliant than women
(OR 1.8, 95% CI: 0.61–5.14;
p
=
0.294) without approaching
significance.
Self-care behavioural adherence
Fig. 2 demonstrates adherence to different self-care behaviours.
Overall, 95% of all study participants kept
≥
75% of their follow-
up appointment schedule and were consequently designated as
compliant. Overall, 81% adhered to 100% of their follow-up
appointment schedule. There was no difference found between
men and women and no major difference between the races in
this regard.
Daily weight monitoring was associated with the lowest rate
of adherence (only 19% of participants having a scale at home),
while avoiding alcohol intake was associated with the highest
rate of adherence. From a dietary behaviour perspective, 87%
of participating patients were non-compliant concerning daily
intake of fruit. However, 64% of participants reported having
difficulty affording fresh fruit. From a smoking perspective, there
were 31 (16%) current smokers and 59 (30%) former smokers.
100
80
60
40
20
0
Beta
blocker
n
=
49
ACE
inhibitor
n
=
42
Loop
diuretic
n
=
42
Spirono-
lactone
n
=
33
Cardiac
Glycoside
n
=
14
% of compliant patients
78
79
64
79
67
Fig. 3. Adherence to individual medication.
n
=
number of
conducted pill counts
100
80
60
40
20
0
Appointment
adherence
Medication
adherence
Self-reported
medication
adherence
Daily
weight
monitoring
Fruit
intake
Fluid
intake
Physical
activity
Smoking
restriction
Moderate
alcohol
intake
% of compliant patients
95
71
82
2,5
13
56
38
84
98
Fig. 2. Reported adherence to self-care behaviour. Appointment adherence was achieved when being present at
≥
75%
of assigned appointments consisting of quarterly check-ups and monthly medication refills at the hospital pharmacy.
Medication adherence represents the number of patients who took
≥
75% of their medication, determined through pill
counts. Adhering to fruit intake meant five servings of fruit per day and adherence in fluid intake was accomplished
when drinking less than two litres per day. Regular physical activity was achieved when study participants walked
moderately for 20 to 30 minutes three to four times a week. A moderate alcohol intake meant one beer or one to two
glasses of wine per day.
