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Cardiovascular Disease |

Complexity in Medication-Taking Behaviors in Heart Failure Patients With Atrial Fibrillation

Nobuyuki Anzai, PhD; Hiroko Anzai; Rieko Mitobe; Makiko Anzai; Kei Goto, RN
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Anzai-Furuya Clinic, Oyama, Japan


Chest. 2014;146(4_MeetingAbstracts):125A. doi:10.1378/chest.1963162
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Abstract

SESSION TITLE: Heart Failure Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM

PURPOSE: Little is known about complexity in medicine -taking behaviors in heart failure (HF) patients with atrial fibrillation(AF).

METHODS: We followed 204 AF patients between January 2013 and December 2013, 34.3%(70/204)had history of HF once or more. To assess medication complexity(special instructions related to medications and behaviors), we studied demographics and clinical characteristcs..

RESULTS: Of the patients, age was 80.3(SD 7.8) years, 66.7%(46/70) were male. 21.7%'19/70) living alone, 70.1 %(50 /70) high school or higher. AF follow up duration was 7.0(SD 3,6) years.98.6%(69/70) was persistent/permanent AF. 67.1%(47/70) had hypertension, 27.1%(19/70) diabetes mellitus,17.15(12/70) stroke,15.7%(11/70) ischemic heart disease,24.3%(17/70) chronic kidny disease(estimated glomerular filtration rate< 45 ml/min/ 1.73 m2, 25.7%(18/70) anemia( Hb<11g/dl), 20.0%(14/70) left ventricular ejection fraction <55%, 12.9%(9/70) locomotive syndrome,11.4%(8/70) dyslipidemia,11.4%(8/70), chronic lung disease,18.6%(13/70) intracardiac device. Mean frequency of comorbidity,HF and hospitalisation were by 3,5(SD 1.6), 1.8(SD 1.0) and 1.9(SD1.3),respectively. Mean CHADS2 scores was 3.0(SD1.1).87.1%(61/70) were on vitamin K antagonist(VKA). Time in therapeutic range was 71.2%(SD24.1). Laboratory monitoring interval was 28.1(SD 4.8) days.Patients had to take mean 8.1(SD 2.6) different medicines daily. Medicines were taken once,twice, three times and ≧4 per day by 8.6%(6/70), 24.3%(17/70), 55.7%(39/70) and 7.1%(5/70), respectively. 28.6%(20/70) took one dose preparations.92.7%(65/70) required special behaviors related to intaking medicine.11.4%(8/70) one behavior, 41.4%(29/70) two and ≧3 47.1%(33/70)(e.g. immediately before each meal.immediately after rising, 1 hour before breackfast and special foods and drugs resriction/prohibition).For instance,taking natto(fermented soy beans, charcteristic Japanese common food, very rich in vitaminK) with VKA is strictively prohibted. Use of VKA with nonsteroidal anti-immflammatory drugs(NSAIDs) is prohibited because of increasing risk of bleeding. Use of NSAIDs is prohibited to prevent HF. Use of nifedipine with grape fruit is prohited due to reinforcing nifedipine effect.

CONCLUSIONS: Prescriptions were overly complex medication regimens with multiple and much medicinces because HF patients with AF have multicomorbidities

CLINICAL IMPLICATIONS: The results may be useful to evaluate medications and simplify madecation-taking behaviors, resulting in reducing burden and improving adherence.

DISCLOSURE: The following authors have nothing to disclose: Nobuyuki Anzai, Hiroko Anzai, Rieko Mitobe, Makiko Anzai, Kei Goto

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