Predictors of objectively measured medication nonadherence in adults with heart failure

Background: Medication nonadherence rates are high. The factors predicting nonadherence in heart failure remain unclear. Methods and Results: A sample of 202 adults with heart failure was enrolled from the northeastern United States and followed for 6 months. Specific aims were to describe the types of objectively measured medication adherence ( eg, taking, timing, dosing, drug holidays ) and to identify contributors to nonadherence 6 months after enrollment. Latent growth mixture modeling was used to identify distinct trajectories of adherence. Indicators of the 5 World Health Organization dimensions of adherence ( socioeconomic, condition, therapy, patient, and healthcare system ) were tested to identify contributors to nonadherence. Two distinct trajectories were identified and labeled persistent adherence ( 77.8% ) and steep decline ( 22.3% ). Three contributors to the steep decline in adherence were identified. Participants with lapses in attention ( adjusted OR, 2.65; P=0.023 ), those with excessive daytime sleepiness ( OR, 2.51; P=0.037 ), and those with ≥2 medication dosings per day ( OR, 2.59; P=0.016 ) were more likely to have a steep decline in adherence over time than to have persistent adherence. Conclusions: Two distinct patterns of adherence were identified. Three potentially modifiable contributors to nonadherence have been identified.