How do older heart failure patients manage their medication? A multi-methods study

  • Roberta Fulton

    Student thesis: Doctoral ThesisDoctor of Philosophy


    Heart Failure (HF), a condition prevalent in older adults goes hand in hand with multiple concurrent diagnoses, polypharmacy and complex drug regimens. Consequently patients with HF need to develop effective strategies to care for themselves whilst managing the burden of multi-morbidities. Currently little is known about which factors influence adherence to medication in this population.

    To understand which factors consistently predict medication adherence in older people with HF a multi-methods study was undertaken. A systematic review of 21 studies reporting on interventions previously evaluated identified 8 which reported significant improvement in medication adherence. Interventions utilised a variety of approaches however heterogeneity in both intervention techniques and measurement methodology resulted in an inability to establish a clear effective approach.

    A rapid review of literature reporting on the perceptions and experiences of people with HF in relation to medicines proved equally inconclusive. Ten qualitative studies were reviewed highlighting non-adherent behaviour as multi-factorial and complex in nature. Individual beliefs, level of knowledge; environmental factors and the role played by significant others emerged as having the potential to influence medication adherence in both a positive and negative way.

    Utilising the information gleaned from the literature reviews a qualitative study was undertaken to explore beliefs around HF and its treatment. Using a purposive sampling strategy eight older HF patients and four nominated carers were recruited from a number of sites to participate in one to one structured interviews. Gender and recent admission to hospital were selected as key variables with carers directly nominated by the patients. Knowledge around both the condition and medication and the association between treatment and symptom control was found to be poor. While patients expressed a belief in the beneficial effects of medications, a wish to remain independent and trust in healthcare professionals were the main reasons given for adherence.

    Finally, a prospective observational study of 60 community dwelling HF patients aged ≥ 70years was undertaken. The primary outcome of adherence to medication was assessed using both direct and indirect methods. The secondary outcome of determinants of adherence were selected following analysis of the qualitative data and literature reviews. Adherence ranged from 74% to 100% depending on the method used however agreement between methods was found to be poor. No single determinant was found to consistently predict adherence across the different measures.
    Date of Award2020
    Original languageEnglish
    SponsorsChief Scientist Office
    SupervisorMiles Witham (Supervisor), Thilo Kroll (Supervisor), Marion McMurdo (Supervisor) & Martyn Jones (Supervisor)

    Cite this