Evaluating Adherence to Medical Therapy in Patients with Chronic Heart Failure: Design and First Results of the COMPLIANCE Study

Aim. To study the adherence of doctors to the guidelines for the treatment of chronic heart failure (СHF) and the adherence of patients with СHF to the therapy prescribed by doctors.

Material and methods. The COMPLIANCE study is an integral part of the PROFILE registry of the specialized cardiology division of the research center. The study includes patients with verified CHF who were previously observed in the PROFILE registry and patients with CHF who have been newly seeking medical care in the period from December 01, 2019 to December 31, 2020. At the first visit, the initial therapy was evaluated, treatment adherence was determined, and treatment was corrected in accordance with current guidelines. The second visit will also assess patient adherence to treatment, assess the factors of non-adherence and complications of diseases during the year of follow-up.

Results. The first 30 case-records of patients with CHF included into the study were analyzed. 90% of patients received angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB). Beta-blockers (BB) were prescribed to 96.7% of patients, and mineralocorticoid receptor antagonists (MRAs) – to 76.7% of patients, and some of them received MRAs at ejection fraction >35%. It was found that the overall adherence of patients according to the adherence scale of the Russian National Society of Evidence-Based Pharmacotherapy (NSEPh) was significantly lower than the adherence to specific drugs. The worst was adherence to ACEI (71%) and MRAs (77%), higher – to BB (86%). The most common factors of non-adherence to treatment, according to the first results, are a large number of medications and a complex medication regimen.

Conclusion. The first part of the COMPLIANCE study showed a relatively good adherence of doctors to current guidelines. However, the choice of the drug and its doses did not always correspond to evidence-based medicine data, existing guidelines and summary of product characteristics (SmPC) of specific drugs. The patients adherence to the prescribed therapy was not bad (this can be explained by long-term follow-up in specialized centers), but it was different for different drugs. The worst adherence was registered to the ACEI/ARB. This is warning factor, since these drugs make a significant contribution to improving the long-term outcome of CHF.

1. Seferovic P.M., Stroerk S., Filippatos G., et al. Organization of heart failure management in European Society of Cardiology member countries: survey of the Heart Failure Association of the European Society of Cardiology in collaboration with the Heart Failure National Societies/Working Groups. Eur J Heart Fail. 2013;15(9):947-59. DOI:10.1093/eurjhf/hft092.

2. Fomin I.V. Chronic heart failure in the Russian Federation: What we know today and what we are supposed to do. Russian Journal of Cardiology. 2016;(8):7-13 (In Russ.) DOI:10.15829/1560-4071-2016-8-7-13.

3. Ponikowski P., Voors A.A., Anker S.D., et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-200. DOI:10.1093/eurheartj/ehw128.

4. Fonarow G.C., Abraham W.T., Albert N.M., et al.; OPTIMIZE-HF Investigators and Hospitals. Ageand gender-related differences in quality of care and outcomes of patients hospitalized with heart failure (from OPTIMIZE-HF). Am J Cardiol. 2009;104(1):107-15. DOI:10.1016/j.amjcard.2009.02.057.

5. Martsevich S.Y., Lukina Y.V., Kutishenko N.P., et al., on behalf of the working group of the observational study PRIORITY. Adherence to Statins Therapy of High and Very High Cardiovascular Risk Patients in Real Clinical Practice: Diagnostics and Possible Ways to Solve the Problem (According to the PRIORITY Observational Study). Rational Pharmacotherapy in Cardiology. 2018;14(6):891-900 (In Russ.) DOI:10.20996/1819-6446-2018-14-6-891-900

6. Martsevich S.Y., Gaysenok O.V., Tripkosh S.G., et al. Medical supervision in specialized center and the quality of lipid-lowering therapy in patients with cardiovascular diseases (according to the PROFILE registry). Rational Pharmacotherapy in Cardiology. 2013;9(2):133-7 (In Russ.)DOI:10.20996/1819-6446-2013-9-2-133-137.

7. Martsevich S.Y., Lukina Y.V., Kutishenko N.P., et al. Adherence to Treatment with New Oral Anticoagulants in Atrial Fibrillation Patients in Real Clinical Practice (Results of the ANTEY Study). Rational Pharmacotherapy in Cardiology. 2019;15(6):864-72 (In Russ.) DOI:10.20996/1819-6446-2019-15-6-864-872.

8. Stegmann O.A. Polikarpov L.S., Novikov O.M. Adherence to treatment of ambulatory patients with chronic heart failure. Sibirskiy Meditsinskiy Zhurnal. 2013;28(2):78-82 (In Russ.)

9. Mitrofanova I.S., Koc Ya.I., Vdovenko L.G. New ways to improve the effectiveness of treatment of patients with chronic heart failure. Journal of Heart Failure. 2016;9(4):164-6 (In Russ.)

10. Fonarow G.C., Abraham W.T., Albert N.M., et al. Age-and gender-related differences in quality of care and outcomes of patients hospitalized with heart failure (from OPTIMIZE-HF). Am J Cardiol. 2009;104(1):107-15. DOI:10.1016/j.amjcard.2009.02.057.

11. Butler J., Arbogast P.G., Daugherty J., et al. Outpatient utilization of angiotensin-converting enzyme inhibitors among heart failure patients after hospital discharge. J Am Coll Cardiol. 2004;43(11):2036-43. DOI:10.1016/j.jacc.2004.01.041.