Download Medication Adherence in Heart Failure

Medication Adherence
in Heart Failure
University of Central Florida
Tessa Dillon
Background Description
Heart failure is a cardiac dysfunction that
limits tissue perfusion
 Medical management includes

 Medication
therapy and daily weights
 Dietary and fluid restrictions
Noncompliance is factor in hospital
readmission rates over 40% (Hodges, 2009)
 Education performed in hospitals is not
adequate

Statement of Clinical Problem
Patients with heart failure have complex
medication regimens, with high incidence
of readmission related to exacerbation of
symptoms.
 Nursing assessment and education
protocols must be implemented to increase
medication adherence and reduce
readmission rates.

Significance

American Heart Association states




the risk of HF for men and women over age 80 is 20%
a 40-year-old man has a lifetime risk of one in five for
developing HF (Lloyd-Jones et al., 2009)
Estimated direct and indirect costs approximately
$37.2 billion (Lloyd-Jones et al.)
Studies show improved medication adherence
and quality of life because of:
 assessing
barriers
 identifying self-care deficits
 applying evidence based treatment guidelines
(Kirk, 2007; Kfoury et al., 2008; MacInnes, 2008; Wu, Moser, Chung, & Lennie, 2008; )
Specific Aims
Medication adherence practices improved
through education and self-evaluation
 Efficacy expectancies

 to
influence patient’s medication adherence
 goal of increasing compliance

Outcomes expected
 decrease
in readmission rates
 better medication adherence
Theory

from Bandura’s social cognitive theory
 self-efficacy
is an element of self-reflection
 offers a link between a person’s actions and their
perceptions of self (Jeng & Braun, 1994)
 middle range theory used to assist patients to optimal
autonomous health


two main concepts of this theory, efficacy
expectation and outcome expectations (Bandura, 2004)
Self-management a system to promote lifestyle
changes necessary to reduce symptoms of
disease (Bandura)
Application of Theory


Patients require close monitoring and
adjustment of medications to maintain health
Nurses improve adherence and quality of life

education programs
 assessing for barriers
 assess the readiness of the client and/or their family
 provide appropriate teaching
 Appropriate referrals to home health agencies

that early patient support boosts patients’
confidence (Rogers & Schott, 2008)
Summary and Conclusion




Hospital readmission for acute failure linked to
medication compliance
Research supports increase adherence to restrictions
and medication regime related to reduction in mortality
and morbidity
Self-efficacy theory uses the knowledge patients will
influence their care with decisions they make
Nursing education protocols based on self-efficacy




increase compliance,
lead to improvements in quality of life for patients
reduce strain on the healthcare system
improve outcomes for patients living with heart failure.
References
Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior,
31(2), 143-164, November 14, 2009. doi:10.1177/1090198104263660
Hodges, P. (2009). Heart failure: Epidemiologic update. Critical Care Nursing Quarterly, 32(1),
24-32, October 31, 2009. doi:10.1097/01.CNQ.0000343131.27318.36
Jeng, C., & Braun, L. T. (1994). Bandura's self-efficacy theory: A guide for cardiac rehabilitation
nursing practice. Journal of Holistic Nursing, 12(4), 425-436, November 14, 2009.
doi:10.1177/089801019401200411
Kfoury, A. G., French, T. K., Horne, B. D., Rasmusson, K. D., Lappé, D. L., Rimmasch, H. L., et
al. (2008). Incremental survival benefit with adherence to standardized heart failure core
measures: A performance evaluation study of 2958 patients. Journal of Cardiac Failure,
14(2), 95-102, October 31, 2009. doi: 10.1016/j.cardfail.2007.10.011
Kirk, M. (2007). Prescribing in heart failure [corrected] [published erratum appears in NURSE
PRESCRIBING 2007 nov;5(10):455]. Nurse Prescribing, 5(9), 385-390. Retrieved October
31, 2009, from EBSCOhost database.
Lloyd-Jones, D., Adams, R., Carnethon, M., De Simone, G., Ferguson, T. B., Flegal, K., et al.
(2009). Heart disease and stroke statistics--2009 update: A report from the american heart
association statistics committee and stroke statistics subcommittee. Circulation, 119(3), e21181, November 2, 2009. doi:10.1161/CIRCULATIONAHA.108.191261
MacInnes, J. (2008). Factors affecting self-care in heart failure: A literature review. British
Journal of Cardiac Nursing, 3(7), 293-299. Retrieved October 31, 2009, from EBSCOhost
database.
Rogers, J. M., & Schott, D. K. (2008). Front loading visits: A best practice measure to decrease
rehospitalization in heart failure patients. Home Health Care Management & Practice, 20(2),
147-153, October 31, 2009. doi:10.1177/1084822307306765
Wu, J., Moser, D. K., Chung, M. L., & Lennie, T. A. (2008). Predictors of medication adherence
using a multidimensional adherence model in patients with heart failure. Journal of Cardiac
Failure, 14(7), 603-614 October 31, 2009. doi: 10.1016/j.cardfail.2008.02.011