Medication non-adherence in heart transplant patients

Poltronieri, Nadja Van Geen; Moreira, Rita Simone Lopes; Schirmer, Janine; Roza, Bartira de Aguiar

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Sumário

ORIGINAL ARTICLE • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2019009203644 copy

Medication non-adherence in heart transplant patients

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

To measure medication non-adherence in patients after heart transplantation using the Basel Assessment of Adherence to Immunosuppressive Medications Scale (BAASIS) and the Visual Analogue Scale (VAS); to compare the results of biopsies performed with the prevalent comorbidities and survival.

Method

Quantitative historical cohort. The population consisted of patients undergoing transplantation between 2009 and 2016.

Results

Participation of 60 patients. The measurement using the BAASIS was 46.7% of non-adherence and 53.3% of patient adherence. The group with greater difficulty in non-adherence reported up to 2 hours delay of medication intake in relation to the prescribed time (25%), although there was no interruption in medications. The initial diagnosis was Chagas disease (33.3%). The studied comorbidities were systemic arterial hypertension (SAH), diabetes mellitus (DM), dyslipidemia (DLP) and chronic renal failure (CRF).

Conclusion

Assessment using the BAASIS showed medication non-adherence in 46.7% of heart transplant patients. The VAS according to patients’ self-report and nurse’s assessment showed high values (93.3% vs 83.3%). The BAASIS tends to address the difficulties reported by patients, when there is a change in doses, delays or anticipations of time and dose.

Medication Adherence; Heart Transplantation; Immunosuppressive Agents; Cardiovascular Nursing

	N	%
Sex
Male	43	71.7
Female	17	28.3
Marital status*
Single	18	30.5
Married	39	66.1
Divorced/separated	2	3.4
No information	1
Living alone
No	53	88.3
Yes	7	11.7
Schooling
Illiterate	4	6.7
Incomplete primary education	17	28.3
Complete primary education	6	10.0
Incomplete high school	11	18.3
Complete high school	15	25.0
Incomplete higher education	3	5.0
Complete higher education	4	6.7
Occupation
Unemployed	3	5.0
Student	6	10.0
Retired	26	43.3
Sickness benefit/pensioner	14	23.3
Housewife	2	3.3
Volunteer	9	15,0
Ethnicity
White	38	63.3
Non-white	62	36.7
Initial diagnosis
Chagas	20	33.3
Congenital	3	5.0
Dilated	16	26.7
Hypertrophic	2	3.3
Ischemic	14	23.3
Peripartum	2	3.3
Valvar	3	5.0
Comorbidities – pre-transplant
Systemic arterial hypertension
No	37	61.7
Yes	23	38.3
Diabetes mellitus	60	100.0
No	53	88.3
Yes	7	11.7
Dyslipidemia
No	42	70.0
Yes	18	30.0
Chronic renal failure	60	100.0
No	51	85.0
Yes	9	15.0
Comorbidities – post-transplant
Systemic arterial hypertension
No	31	51.7
Yes	29	48.3
Diabetes mellitus
No	45	75.0
Yes	15	25.0
Dyslipidemia
No	42	70.0
Yes	18	30.0
Chronic renal failure
No	42	70.0
Yes	18	30.0
Other ocurrences post-transplant
Neoplasias
No	54	90.0
Yes	6	10.0
Chagas reactivation
No	51	85.0
Yes	9	15.0
Cytomegalovirus reinfection
No	45	75.0
Yes	15	25.0
Hospitalization	60	100.0
No	39	65.0
Yes	21	35.0

Distribution	N	%
Do you recall of forgetting to take your immunosuppressive medications in the past four weeks?
No	51	85.0
Yes	9	15.0
Frequency of forgetting to take immunosuppressive medications at any time in the past four weeks
Never	51	85.0
Once	7	11.7
Twice	2	3.3
Do you remember skipping two or more doses of immunosuppressive medications in the past four weeks?
No	55	91.7
Yes	5	8.3
Frequency of having skipped two or more doses of immunosuppressive medications in the past four weeks
Never	55	91.7
Once	2	3.3
Twice	1	1.7
Three times	1	1.7
Four times	1	1.7
In the past four weeks, do you remember taking immunosuppressive medications 2 hours in advance or two hours behind the prescribed time?
No	45	75.0
Yes	15	25.0
Frequency with which you remember taking immunosuppressive medications with more than 2 hours’ difference compared to the prescribed time, in the last four weeks
Never	45	75.0
Once	6	10.0
Two or three times	8	13.3
Four or five times	1	1.7
In the past four weeks, have you changed the amount of immunosuppressive medications without medical advice?
No	53	88.3
Yes	7	11.7
In the past year, have you completely stopped taking immunosuppressive medications without medical advice?
No	60	100.0
Adherence
Non-adherence	28	46.7
Adherence	32	53.3

Endocardial biopsy	Adherence						p
	No		Yes		Total
	N	%	N	%	N	%
1 ^st month	28	100.0%	32	100.0%	60	100.0%	0.088^a
No rejection	2	7.1%	8	25.0%	10	16.7%
Rejection	26	92.9%	24	75.0%	50	83.3%
3 ^rd month	28	100.0%	32	100.0%	60	100.0%	0.775
No rejection	7	25.0%	7	21.9%	14	23.3%
Rejection	21	75.0%	25	78.1%	46	76.7%
6 ^th month	28	100.0%	32	100.0%	60	100.0%	0.796
No rejection	6	21.4%	6	18.8%	12	20.0%
Rejection	22	78.6%	26	81.3%	48	80.0%

	Mean	Standard Deviation	Min.	Max.	1st quartile	Median	3rd quartile	N
Adherence – self-reported (VAS)	93.3%	11.6%	50.0%	100.0%	90.0%	100.0%	100.0%	60
Adherence – nurse	82.5%	19.1%	50.0%	100.0%	70.0%	80.0%	100.0%	60

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Bartira de Aguiar Roza Rua Napoleão de Barros, 754, Vila Clementino CEP 04024-002 – São Paulo, SP, Brazil bartira.roza@unifesp.br