Polypill

Medication Adherence and Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran

Background:

Heart failure is a costly condition with high morbidity and mortality rates in low- and middle-income countries. Nonadherence to prescribed therapies can lead to severe problems such as poorer health outcomes, higher health care expenditures, increased hospitalizations, and even higher mortality rates in patients with advanced heart disease.

Objective:

The aim of the present study is to investigate medication adherence and the association between medication adherence and health literacy in Iranian patients with heart failure.

Methods:

This study was conducted in the heart failure outpatient clinic of Shahid Rajaee Cardiovascular, Medical, and Research Center in Tehran, Iran. Medical records and validated questionnaires were used to collect the necessary information on the survey variables, including sociodemographic characteristics, medication adherence, and health literacy, for a total of 250 patients with heart failure. Stepwise logistic regression analysis was performed to identify the variables that independently and significantly predicted medication nonadherence.

Key Results:

The results showed that most patients with heart failure had low medication adherence. Some factors, including gender, health literacy, and duration of illness, were associated with adherence. The study results showed a positive association between higher health literacy and better medication adherence.

Conclusion:

In view of the results, further studies on heart failure are needed to investigate other factors related to medication adherence and health literacy level to achieve better disease management and improve patients' treatment adherence. [HLRP: Health Literacy Research and Practice. 2022;6(3):e191–e199.]

Plain Language Summary:

This study investigated the relationship between medication adherence and health literacy in Iranian patients with heart failure. The results showed that most patients had inadequate health literacy. Moreover, it showed a significant and positive relationship between health literacy and medication adherence.

The value of the polypill in cardiovascular disease: an Italian multidisciplinary Delphi panel consensus

The purpose of this work was to reach the consensus of a multidisciplinary and multistakeholder Italian panel on the value of polypill in cardiovascular disease, with respect to the clinical, technological, economic and organizational dimension. A three-step modified Delphi method was used to establish consensus. Eleven experts in the area of cardiology, pharmaceutical technology, general practice, hospital pharmacy, pharmacology, and health economics participated in the expert panel. To identify existing evidence concerning the value of polypill in the prevention of patients with cardiovascular disease, a systematic literature review was carried out according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement guidelines. In the first round, 22 statements were distributed to the panel. Panel members were asked to mark 'agree' or 'disagree' for each statement and provide any comments. The same voting method was again used for the second round. In the first round nine statements met consensus. In the second round, 10 statements reached consensus. Overall, consensus was reached for 19 statements representing five value polypill domains: clinical, technological, economic and organizational. During a final web meeting with all panel members consensus document open points were discussed. Panel members agreed to recognize polypill as effective in reducing cardiovascular events, blood pressure and lipids, cardiovascular risk and the weight of therapy, in therapeutic adherence improvement, in the absence of differences in bioavailability between drugs administered in fixed or free combinations and the better cost-effectiveness profile compared with standard care. This document represents a knowledge framework to inform decision makers of the value of polypill in cardiovascular prevention.

Beta-blocker therapy reduces mortality in patients with coronary artery disease treated with percutaneous revascularization: a meta-analysis of adjusted results

AIMS

The long-term impact of beta blockers on prognosis in patients treated with contemporary therapies for coronary artery disease remains to be defined.

METHODS AND RESULTS

All observational studies evaluating the impact of beta blockers in patients treated with coronary revascularization and contemporary therapies and adjusted with multivariate analysis were included. All-cause death was the primary endpoint, while Major Adverse Cardiac Events (MACE) (composite endpoint of all-cause death or myocardial infarction, MI) and MI were secondary endpoints. A total of 26 studies were included, with 863 335 patients. After 3 (1-4.3) years, long-term risk of all-cause death was lower in patients on beta blockers [odds ratio, OR 0.69 (0.66-0.72)], both for Acute Coronary Syndrome (ACS) [OR 0.60 (0.56-0.65)], and stable angina patients [OR 0.84 (0.78-0.91)], independently from ejection fraction [OR 0.64 (0.42-0.98) for reduced ejection fraction and OR 0.79 (0.69-0.91) for preserved ejection fraction]. The risk of long-term MACE was lower but NS for ACS patients treated with beta blockers [OR 0.83 (0.69-1.00)], as in stable angina. Similarly, risk of MI did not differ between patients treated with beta blockers or without beta blockers [OR 0.99 (0.89-1.09), all 95% confidence intervals]. Using meta-regression analysis, the benefit of beta blockers was increased for those with longer follow-up. The number needed to treat was 52 to avoid one event of all-cause death for ACS patients and 111 for stable patients.

CONCLUSION

Even in percutaneous coronary intervention era, beta blockers reduce mortality in patients with coronary artery disease, confirming their protective effect, which was consistent for both ACS and stable patients indifferently of preserved or reduced ejection fraction.

A critical courier role of volatile oils from Dalbergia odorifera for cardiac protection in vivo by QiShenYiQi

Component-based Chinese medicine (CCM) is derived from traditional Chinese medicine but produced with modern pharmaceutical standard and clearer clinical indications. However, it still faces challenges of defining individual component contribution in the complex formula. Using QiShenYiQi (QSYQ) as a model CCM, we investigated the role of Dalbergia odorifera (DO), an herbal component, in preventing myocardial damage. We showed that in vitro, QSYQ exerted considerable protective activities on cardiomyocytes from H₂O₂-induced mitochondrial dysfunction with or without DO. However, in isolated rat hearts, myocardial protection by QSYQ was significantly weakened without DO. In everted gut sac model, DO significantly enhanced absorption of the major QSYQ ingredients in different regions of rat intestine. Finally, in in vivo mouse model of doxorubicin (DOX)-induced myocardial damage, only QSYQ, but not QiShenYiQi without DO (QSYQ-DO), exerted a full protection. Taken together, our results showed that instead of directly contributing to the myocardial protection, Dalbergia odorifera facilitates the major active ingredients absorption and increases their efficacy, eventually enhancing the in vivo potency of QSYQ. These findings may shed new lights on our understanding of the prescription compatibility theory, as well as the impacts of “courier herbs” in component-based Chinese medicine.