Heart diseases are the leading cause of death in Spain, representing 30% of deaths per year.
The cardiology patient consults with the intention of being cured and recovering his or her normal life as soon as possible. Being pharmacological treatment, it is the cornerstone that allows us to achieve this objective and it is within the doctor's responsibilities to ensure that his patient complies with the indicated treatment.
The World Health Organization (WHO) defines treatment adherence as the degree to which a patient's behavior, in relation to taking medication, following a diet or modifying lifestyle habits, corresponds with the recommendations agreed with the health professional
It is estimated that in Spain 50% of patients comply correctly with treatment; adherence levels vary depending on the type of pathology. In the case of cardiovascular disease, it has been determined that 22,4% of patients abandoned the treatment prescribed by hospital care doctors and up to 39,4% by primary care doctors.
Adherence to treatment would allow for a 44% reduction in major cardiovascular events compared to non-adherent patients and a 24% reduction compared to non-adherent patients. For example, in heart failure, for every increase in adherence, emergency department visits decreased by 11%, hospital admissions decreased by 6%, the total length of hospital stay decreased by 1%, and all-cause mortality decreased by 9%.<sup> 10 </sup> This clearly demonstrates the need to increase the percentage of patients adhering to treatment, which would translate into fewer relapses, fewer complications, and lower morbidity and mortality.
Tools to improve adhesion
There are a series of tools that allow measuring, knowing and therefore trying to improve the patient's adherence. This section will focus on the tools that allow improving adherence and later we will talk about the
a) Improve knowledge and attitudes about the disease presented and the prescribed treatment.
b) Guidelines aimed at reminding the patient of the medication schedule : this aspect may be the most important action, including telephone calls, mechanisms with alarms that sound at the time of taking the medication, medication organizers of different shapes and models, packaging of the medication with calendar blisters, medication cards where it is noted that the medication has been taken, promoting the patient's self-efficacy so that they are able to associate taking the medication with an activity in their daily life.
c) Reduce fear of possible adverse effects of medication and empower patients to act on them.
d) Social, family and health support
e) Help the patient decide on adherence.
f) Combination of tools : The best strategy is a combination of tools that address different aspects. The most successful intervention includes regular calls from a healthcare professional, answering questions about medication, emphasizing the importance of adherence, and promoting it through advice. Studies that implemented a multifactorial intervention for hypertension, using a kit that provided a one-month supply of medication, written materials explaining the importance of adherence, and telephone calls, achieved a 35% improvement in compliance.
Conclusions
It is important to have tools that allow us to identify whether the patient is complying with the treatment indicated for their cardiovascular disease and from there, use strategies that allow for an improvement in adherence, taking into account that the ideal is not a single strategy but the combined use of them, hoping that it will translate into a reduction in morbidity and mortality and better clinical outcomes.
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Dr. Jefferson Salas Castro – UICAR Cardiologist