Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients.

Abstract

Background

Poor adherence to evidence-based medications in heart failure (HF) is a major cause of avoidable hospitalizations, disability, and death. To test the feasibility of improving medication adherence, we performed a randomized proof-of-concept study of a self-management intervention in high-risk patients with HF.

Methods

Patients with HF who screened positively for poor adherence (<6 Morisky Medication Adherence Scale 8-item) were randomized to either the intervention or attention control group. In the intervention group (n = 44), a nurse conducted self-management training before discharge that focused on identification of medication goals, facilitation of medication-symptom associations, and use of a symptom response plan. The attention control group (n = 42) received usual care; both groups received follow-up calls at 1 week. However, the content of follow-up calls for the attention control group was unrelated to HF medications or symptoms. General linear mixed models were used to evaluate the magnitude of change in adherence and symptom-related events at 3-, 6-, and 12-month follow-up clinic visits. Efficacy was measured as improved medication adherence using nurse-assessed pill counts at each time point.

Results

Pooled over all time points, patients in the intervention group were more likely to be adherent to medications compared with patients in the attention control group (odds ratio 3.92, t = 3.51, P = .0007).

Conclusions

A nurse-delivered, self-care intervention improved medication adherence in patients with advanced HF. Further work is needed to examine whether this intervention can be sustained to improve clinical outcomes.

Department

Description

Provenance

Citation

Published Version (Please cite this version)

10.1016/j.ahj.2015.01.006

Publication Info

Granger, Bradi B, Inger Ekman, Adrian F Hernandez, Tenita Sawyer, Margaret T Bowers, Tracy A DeWald, Yanfang Zhao, Janet Levy, et al. (2015). Results of the Chronic Heart Failure Intervention to Improve MEdication Adherence study: A randomized intervention in high-risk patients. American heart journal, 169(4). pp. 539–548. 10.1016/j.ahj.2015.01.006 Retrieved from https://hdl.handle.net/10161/29998.

This is constructed from limited available data and may be imprecise. To cite this article, please review & use the official citation provided by the journal.

Scholars@Duke

Granger

Bradi Bartrug Granger

Research Professor in the School of Nursing

Dr. Bradi Granger is a Research Professor at Duke University School of Nursing, Director of the Duke Heart Center Nursing Research Program, and adjunct faculty at the University of Gothenburg, Sweden. She is also a core faculty at the Duke-Margolis Center for Health Policy. Dr. Granger received her doctorate in nursing from the University of North Carolina at Chapel Hill, her MSN from Duke University, and her BSN from the University of Tennessee at Knoxville.

Dr. Granger has extensive clinical experience in cardiovascular nursing, and her clinical work as a Clinical Nurse Specialist has been dedicated to overcoming barriers to the use and conduct of research in the service setting through the development of pragmatic tools that change the way nurses learn about, apply, and conduct nursing science. She has developed an innovative model for clinical inquiry and research in the hospital setting, which has been adopted in clinical settings across the U.S. and abroad. Dr. Granger is an active member of the Council for the Advancement of Nursing Science, the American Association of Critical Care Nurses, the American Heart Association, and the European Society for Patient Adherence, Compliance, and Persistence. 

Bowers

Margaret Therese Bowers

Clinical Professor in the School of Nursing

Midge Bowers is a Clinical Professor and Director of the Cardiovascular Specialty at Duke University School of Nursing in Durham, NC. She holds a secondary appointment in the Department of Medicine in the Division of Cardiology as a nurse practitioner. Dr. Bowers earned her BSN from Binghamton University, her MSN as a Clinical Nurse Specialist in critical care at Duke University School of Nursing and completed a Post-Master’s Certificate as a Family Nurse Practitioner at Duke. Subsequently she joined the faculty in 1999. She earned the Doctor of Nursing Practice degree from the University of Colorado-Denver. Her clinical practice focuses on patients with heart failure and her scholarly work is focused on cardiovascular topics and simulation. As an Associate in the American College of Cardiology and a certified health simulation educator she is the only nurse practitioner on the leadership team of the ACC simulation council. She is actively involved in the American Association of Nurse Practitioners engaged in leadership roles in the Gerontological Advanced Practice Nurses Association. She received the American Association of Nurse Practitioners State Award for Excellence in 2014 and was inducted as an AANP Fellow the same year. Her expertise in cardiovascular care was acknowledged as the recipient of the Faculty Clinical Practice Excellence award in 2017. Her contributions to the nursing profession were recognized in 2019 when she was inducted as a Fellow in the American Academy of Nursing.  In 2024 she was inducted as a Fellow in the American College of Cardiology.



Bosworth

Hayden Barry Bosworth

Professor in Population Health Sciences

Dr. Bosworth is a health services researcher and Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)  at the Durham VA Medical Center. He is also Vice Chair of Education and Professor of Population Health Sciences. He is also a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center and Adjunct Professor in Health Policy and Administration at the School of Public Health at the University of North Carolina at Chapel Hill. His research interests comprise three overarching areas of research: 1) clinical research that provides knowledge for improving patients’ treatment adherence and self-management in chronic care; 2) translation research to improve access to quality of care; and 3) eliminate health care disparities. 

Dr. Bosworth is the recipient of an American Heart Association established investigator award, the 2013 VA Undersecretary Award for Outstanding Achievement in Health Services Research (The annual award is the highest honor for VA health services researchers), and a VA Senior Career Scientist Award. In terms of self-management, Dr. Bosworth has expertise developing interventions to improve health behaviors related to hypertension, coronary artery disease, and depression, and has been developing and implementing tailored patient interventions to reduce the burden of other chronic diseases. These trials focus on motivating individuals to initiate health behaviors and sustaining them long term and use members of the healthcare team, particularly pharmacists and nurses. He has been the Principal Investigator of over 30 trials resulting in over 400 peer reviewed publications and four books. This work has been or is being implemented in multiple arenas including Medicaid of North Carolina, private payers, The United Kingdom National Health System Direct, Kaiser Health care system, and the Veterans Affairs.

Areas of Expertise: Health Behavior, Health Services Research, Implementation Science, Health Measurement, and Health Policy


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