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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Objectively measured medication adherence using assays for carvedilol and enalaprilat in patients with heart failure in Mozambique and Nigeria
International Journal of Cardiology: Cardiovascular Risk and Prevention, Volume 19, Article 200213, Year 2023
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Description
Background: Poor medication adherence leads to poor health outcomes and increased healthcare costs among patients with heart failure (HF). This study aimed to objectively assess medication adherence by measuring carvedilol and enalaprilat plasma concentrations among patients with HF. Methods: The present sub-study of the Safety, Tolerability, and Efficacy of Rapid Optimization, helped by NT-proBNP testing, of Heart Failure therapies (STRONG-HF) study involved adult patients with acute HF admitted in two Mozambican and two Nigerian hospitals who were not optimally treated with oral enalapril and carvedilol. Patients in the high-intensity arm of the STRONG-HF study, and those not meeting the biomarker criteria for persistent congestion, were included in the “frequent visit” (FV) arm. In the FV arm, blood for bioanalysis of plasma enalaprilat or/and carvedilol was drawn at the 2,6,12th week post-discharge. Patients in the usual care arm of STRONG-HF were included in the “standard visit” (SV) arm, which followed the usual local practice with blood sampling in week 12. Results: The study involved 113 (79 FV and 34 SV) participants with a mean age of 48.6 years and a mean left ventricular (LV) ejection fraction of 33.1%. Theenalaprilat below the lower level of quantification (LLOQ) was documented in 7.7%, 11.9%, and 15.6% of participants in FV during the 2,6 and 12th weeks. Carvedilol concentration below LLOQ was documented in 37%, 30%, and 44.4% of participants in the FV arm during the 2,6 and 12th weeks, respectively. For the SV arm, enalaprilat and carvedilol concentrations below LLOQ in the twelfth week were documented in 37.3% and 42.9% of patients, respectively. Conclusion: Up to a third of patients using enalapril and carvedilol did not take any medication during the 12 weeks of follow-up. Non adherence was more common in patients who had less follow up, emphasizing the importance of close follow up to adherence. No adherence was also more common in medications know to have more side effects such as carvedilol. © 2023 The Authors
Authors & Co-Authors
Mwita, Julius Chacha
Botswana, Gaborone
Princess Marina Hospital
Joubert, Andre
South Africa, Cape Town
University of Cape Town
Sa’idu, Hadiza
Nigeria, Kano
Bayero University
Sani, Mahmoud Umar
Nigeria, Kano
Bayero University
Damasceno, A. Antonio Moura
Mozambique, Maputo
Universidade Eduardo Mondlane
Mozambique, Maputo
Hospital Central de Maputo
Mocumbi, Ana Olga H.
Mozambique, Maputo
Universidade Eduardo Mondlane
Mozambique, Vila de Marracuene
Instituto Nacional de Saúde Ins
Sinxadi, Phumla Zuleika
South Africa, Cape Town
University of Cape Town
Viljoen, Charle André
South Africa, Cape Town
University of Cape Town
Hoevelmann, Julian
South Africa, Cape Town
University of Cape Town
South Africa, Cape Town
Faculty of Health Sciences
Germany, Homburg
Universitätsklinikum Des Saarlandes Medizinische Fakultät Der Universität Des Saarlandes
Gebreyesus, Manna Semere
South Africa, Cape Town
University of Cape Town
Denti, Paolo
South Africa, Cape Town
University of Cape Town
Wasmann, Roeland E.
South Africa, Cape Town
University of Cape Town
Maartens, Gary Tuberculosis
South Africa, Cape Town
University of Cape Town
Wiesner, L. D.
South Africa, Cape Town
University of Cape Town
Stewart, Simon D.
Mozambique, Maputo
Universidade Eduardo Mondlane
Australia, Fremantle
The University of Notre Dame Australia
United Kingdom, Glasgow
University of Glasgow
Australia, Brisbane
Griffith University
Davison, Beth A.
United States, Durham
Momentum Research, Inc
France, Paris
Inserm
Cotter, Gad
United States, Durham
Momentum Research, Inc
France, Paris
Inserm
Sliwa, Karen S.
South Africa, Cape Town
University of Cape Town
South Africa, Cape Town
Faculty of Health Sciences
Statistics
Authors: 18
Affiliations: 13
Identifiers
Doi:
10.1016/j.ijcrp.2023.200213
ISSN:
27724875
Research Areas
Health System And Policy
Study Design
Cohort Study
Study Locations
Mozambique
Nigeria