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 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%, total length of hospital stay decreased by 1%, and mortality from all the causes decreased by 9%.10 That said, the need to increase the percentage of patients adhering to treatment is obvious, which would translate into fewer relapses, fewer complications and less 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 remembering the time of taking medication: this aspect may be the most important action, it includes 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 blister packs, medication letters where It is noted that the medication has been taken, promoting the patient's self-efficacy so that they are able to associate taking it with an activity in their daily life.
c) Reduce fear of possible adverse effects of medication and enable patients to act on them.
d) Social, family and health support
e) Help the patient decide about adherence.
f) Tool combination: The best strategy is the combination of tools that act on different aspects. The most successful intervention includes regular calls from a healthcare professional, answering questions about medication, reminding people of the importance of adherence, and encouraging it through advice. Studies where a multifactorial intervention in HTN was carried out, using a kit that provided a supply of medication for one month, written material with an explanation of the importance of adherence, as well as telephone calls, obtaining an improvement in compliance by 35 %.
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