PMID- 18203116
OWN - NLM
STAT- MEDLINE
DCOM- 20080325
LR  - 20211020
IS  - 0160-9289 (Print)
IS  - 1932-8737 (Electronic)
IS  - 0160-9289 (Linking)
VI  - 31
IP  - 1
DP  - 2008 Jan
TI  - Factors associated with non-adherence to therapy with warfarin in a population of 
      chronic heart failure patients.
PG  - 30-4
LID - 10.1002/clc.20175 [doi]
AB  - BACKGROUND: Adherence to heart failure therapy is important in reducing morbidity 
      and mortality over the course of the disease process. The aim of this study was 
      to examine factors associated with non-adherence to warfarin in chronic heart 
      failure patients. METHODS: Eighty patients receiving warfarin therapy in 2002 
      were included. Adherence was defined as maintenance of international normalized 
      ratio (INR) between 2 and 3.5 and keeping scheduled appointments for INR checks 
      at least 75% of the time. Clinical variables examined included age, gender, race, 
      insurance, left ventricular ejection fraction (LVEF), etiology, New York heart 
      association (NYHA) class, comorbidities, smoking, and alcohol use. RESULTS: Of 80 
      patients studied, 59 were male with mean age ( +/- standard deviation) 52 +/- 13 
      years, 24 had ischemic etiology with mean LVEF of 24% +/- 9%. Non-adherence was 
      associated with tobacco use, odds ratio of 6.5 (p <0.01). Ischemic etiology was 
      associated with adherence, odds ratio of 4.5 (p <0.01). Non-adherent patients 
      were more likely to be insured with Medicare/Medicaid (p = 0.04) and have better 
      NYHA class (p = 0.04). Adherence positively correlated with older age and lower 
      LVEF, and negatively correlated with number of hospitalizations (p<0.01 for all). 
      In a multiple regression model, patients with improvement in LVEF had decreased 
      adherence over the year (p<0.01). CONCLUSIONS: The profile of heart failure 
      patients who demonstrated non-adherence to warfarin therapy included younger age, 
      nonischemic etiology, better NYHA class, smoking, insurance with 
      Medicare/Medicaid and improved LVEF over the study. Measures targeting these 
      patients may result in improved adherence to other pharmacologic treatments of 
      heart failure.
CI  - 2007 Wiley Periodicals, Inc
FAU - Pamboukian, Salpy V
AU  - Pamboukian SV
AD  - The University of Alabama at Birmingham, Birmingham, Alabama, USA. svpam@uab.edu
FAU - Nisar, Imran
AU  - Nisar I
FAU - Patel, Sheetal
AU  - Patel S
FAU - Gu, Liping
AU  - Gu L
FAU - McLeod, Mary
AU  - McLeod M
FAU - Costanzo, Maria Rosa
AU  - Costanzo MR
FAU - Heroux, Alain
AU  - Heroux A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Clin Cardiol
JT  - Clinical cardiology
JID - 7903272
RN  - 0 (Anticoagulants)
RN  - 5Q7ZVV76EI (Warfarin)
SB  - IM
MH  - Anticoagulants/*therapeutic use
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Failure/*drug therapy/epidemiology
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Morbidity
MH  - Prognosis
MH  - Retrospective Studies
MH  - Risk Factors
MH  - Survival Rate
MH  - Treatment Refusal/*statistics & numerical data
MH  - United States/epidemiology
MH  - Warfarin/*therapeutic use
PMC - PMC6653211
EDAT- 2008/01/19 09:00
MHDA- 2008/03/26 09:00
PMCR- 2008/01/17
CRDT- 2008/01/19 09:00
PHST- 2008/01/19 09:00 [pubmed]
PHST- 2008/03/26 09:00 [medline]
PHST- 2008/01/19 09:00 [entrez]
PHST- 2008/01/17 00:00 [pmc-release]
AID - CLC20175 [pii]
AID - 10.1002/clc.20175 [doi]
PST - ppublish
SO  - Clin Cardiol. 2008 Jan;31(1):30-4. doi: 10.1002/clc.20175.