Association of Medication Adherence and Health Status in Heart Failure With Reduced Ejection Fraction: Insights From the CHAMP-HF Registry.

Background: The foundation for managing heart failure with reduced ejection fraction (HFrEF) is adherence to guideline-directed medical therapy. Finding an association between medication adherence and patients' health status (their symptoms, function, and quality of life) can be used to underscore its importance to patients.
Methods: The association of self-reported medication adherence in US outpatients with HFrEF enrolled in the Change the Management of Patients with Heart Failure registry from 2015 to 2017 was compared with their health status at baseline and 12 months later. A secondary analysis of changes in adherence between baseline and 6 months with 6-month health status was also performed. Medication adherence was assessed with the self-reported 4-item Morisky-Green-Levine Medication Adherence Scale, with scores ≥1 classified as nonadherent. The primary health status outcome was the disease-specific 12-item Kansas City Cardiomyopathy Questionnaire Overall Summary Score (KCCQ-OS; range, 0-100; higher is better). Robust linear regression models adjusted for confounders were used.
Results: After excluding those who died (n=316) or did not provide 12-month KCCQ (n=1285), 3495 outpatients with HFrEF were included, of whom 1108 (31.7%) reported being nonadherent. Nonadherent participants were younger, had significantly worse baseline health status (-5.83-point difference; P <0.001), and showed less improvement at 12 months (-1.7-point difference in mean change; P =0.017) than adherent participants. Among nonadherent patients at baseline, those whose adherence improved trended toward greater 6-month health status improvements than those remaining nonadherent (fully adjusted difference of 2.52 points; P =0.054).
Conclusions: In HFrEF, medication nonadherence was associated with worse health status and less improvement over the following year. Improvements in adherence were associated with better health status than remaining nonadherent, underscoring the importance of supporting adherence with guideline-directed medical therapy in patients with HFrEF.
Competing Interests: Dr El-Zein is currently supported by the National Heart, Lung, and Blood Institute (NHLBI) under award number T32H110837. The content is solely the responsibility of the author(s) and does not necessarily represent the official views of the National Institutes of Health. Dr DeVore reports research funding through his institution from the American Heart Association, Amgen, AstraZeneca, Bayer, Intra-Cellular Therapies, American Regent Inc, the NHLBI, Novartis, and Patient-Centered Outcomes Research Institute. He also provides consulting services for Amgen, AstraZeneca, Bayer, CareDx, InnaMed, LivaNova, Mardil Medical, Novartis, Procyrion, scPharmaceuticals, Story Health, and Zoll. He has also received nonfinancial support from Abbott for educational activities. Dr Thomas reports research funding Novartis. Dr Albert reports serving as a consultant to Novartis, Amgen, AstraZeneca, and Boston Scientific. Dr Butler has received research support from the National Institutes of Health, PCORI and the European Union; and serves as a consultant for Amgen, Array, Astra Zeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squib, CVRx, G3 Pharmaceutical, Innolife, Janssen, Luitpold, Medtronic, Merck, Novartis, Relypsa, StealthPeptide, SC Pharma, Vifor, and ZS Pharma. Dr Hernandez has received research support from the American Heart Association, AstraZeneca, Merck, NHLBI, Luitpold, and Novartis, and honorarium from Bayer, Boston Scientific, and Novartis. Dr Patterson reports research funding from Amgen, Bristol Myers Squibb, Merck, and Novartis, and serves as a consultant to Amgen and Novartis. Dr Spertus reports research funding from NIH, Janssen, and Bristol Meyers Sqiubb. He served as a consultant to Bayer, Bristol Meyers Squibb, Merck, Janssen, Kinksia, Imbria, Cytokinetics, Alnylam, Sanofi Aventis, and United Healthcare. He owns the copyright to the Seattle Angina Questionnaire, Kansas City Cardiomyopathy Questionnaire and Peripheral Artery Questionnaire and serves on the Board of Directors for Blue Cross Blue Shield of Kansas City. Dr Fonarow reports research funding from the National Institutes of Health and consulting for Abbott, Amgen, AstraZeneca, Bayer, Cytokinetics, Janssen, Merck, Novartis, and Medtronic. The other authors report no conflicts.