Medication Adherence in Heart Failure University of Central Florida Tessa Dillon

Background Description Heart failure is a cardiac dysfunction that limits tissue perfusion Medical management includes  Medication therapy and daily weights  Dietary and fluid restrictions Noncompliance is factor in hospital readmission rates over 40% (Hodges, 2009) Education performed in hospitals is not adequate

Statement of Clinical Problem Patients with heart failure have complex medication regimens, with high incidence of readmission related to exacerbation of symptoms. Nursing assessment and education protocols must be implemented to increase medication adherence and reduce readmission rates.

Significance American Heart Association states  the risk of HF for men and women over age 80 is 20%  a 40-year-old man has a lifetime risk of one in five for developing HF (Lloyd-Jones et al., 2009) Estimated direct and indirect costs approximately $37.2 billion (Lloyd-Jones et al.) Studies show improved medication adherence and quality of life because of:  assessing barriers  identifying self-care deficits  applying evidence based treatment guidelines (Kirk, 2007; Kfoury et al., 2008; MacInnes, 2008; Wu, Moser, Chung, & Lennie, 2008; )

Specific Aims Medication adherence practices improved through education and self-evaluation Efficacy expectancies  to influence patient’s medication adherence  goal of increasing compliance Outcomes expected  decrease in readmission rates  better medication adherence

Theory from Bandura’s social cognitive theory  self-efficacy is an element of self-reflection  offers a link between a person’s actions and their perceptions of self (Jeng & Braun, 1994)  middle range theory used to assist patients to optimal autonomous health two main concepts of this theory, efficacy expectation and outcome expectations (Bandura, 2004) Self-management a system to promote lifestyle changes necessary to reduce symptoms of disease (Bandura)

Application of Theory Patients require close monitoring and adjustment of medications to maintain health Nurses improve adherence and quality of life  education programs  assessing for barriers  assess the readiness of the client and/or their family  provide appropriate teaching  Appropriate referrals to home health agencies that early patient support boosts patients’ confidence (Rogers & Schott, 2008)

Summary and Conclusion Hospital readmission for acute failure linked to medication compliance Research supports increase adherence to restrictions and medication regime related to reduction in mortality and morbidity Self-efficacy theory uses the knowledge patients will influence their care with decisions they make Nursing education protocols based on self-efficacy  increase compliance,  lead to improvements in quality of life for patients  reduce strain on the healthcare system  improve outcomes for patients living with heart failure.

References Bandura, A. (2004). Health promotion by social cognitive means. Health Education & Behavior, 31(2), , November 14, doi: / Hodges, P. (2009). Heart failure: Epidemiologic update. Critical Care Nursing Quarterly, 32(1), 24-32, October 31, doi: /01.CNQ Jeng, C., & Braun, L. T. (1994). Bandura's self-efficacy theory: A guide for cardiac rehabilitation nursing practice. Journal of Holistic Nursing, 12(4), , November 14, doi: / Kfoury, A. G., French, T. K., Horne, B. D., Rasmusson, K. D., Lappé, D. L., Rimmasch, H. L., et al. (2008). Incremental survival benefit with adherence to standardized heart failure core measures: A performance evaluation study of 2958 patients. Journal of Cardiac Failure, 14(2), , October 31, doi: /j.cardfail Kirk, M. (2007). Prescribing in heart failure [corrected] [published erratum appears in NURSE PRESCRIBING 2007 nov;5(10):455]. Nurse Prescribing, 5(9), Retrieved October 31, 2009, from EBSCOhost database. Lloyd-Jones, D., Adams, R., Carnethon, M., De Simone, G., Ferguson, T. B., Flegal, K., et al. (2009). Heart disease and stroke statistics update: A report from the american heart association statistics committee and stroke statistics subcommittee. Circulation, 119(3), e21-181, November 2, doi: /CIRCULATIONAHA MacInnes, J. (2008). Factors affecting self-care in heart failure: A literature review. British Journal of Cardiac Nursing, 3(7), Retrieved October 31, 2009, from EBSCOhost database. Rogers, J. M., & Schott, D. K. (2008). Front loading visits: A best practice measure to decrease rehospitalization in heart failure patients. Home Health Care Management & Practice, 20(2), , October 31, doi: / Wu, J., Moser, D. K., Chung, M. L., & Lennie, T. A. (2008). Predictors of medication adherence using a multidimensional adherence model in patients with heart failure. Journal of Cardiac Failure, 14(7), October 31, doi: /j.cardfail