Patients on chronic CV therapies experience medication-related burden on daily life aspects
The impact of cardiovascular medication use on patients’ daily lives: a cross‑sectional studyLiterature - van der Laan DM, Elders PJM, Boons CCLM, et al. - Int J Clin Pharm 2018; published online ahead of print
Patients with chronic diseases, particularly cardiovascular (CV) diseases, are confronted with long-term and complex treatments that affect their quality of life . These patients often have difficulties to adhere to their therapies, and may become non-adherent, which leads to increased morbidity and mortality .
This cross-sectional study evaluated the impact of life-long CV medication use on different aspects of patients’ daily lives , and the differences of these aspects between adherent and non-adherent patients were assessed. For this purpose, the Living with Medicines Questionnaire (LMQ-2)  was sent to patients aged ≥45 years who were prescribed CV medications including anti-hypertensives, anticoagulants, and lipid-lowering medications for more than 1 year. The LMQ-2 measures the impact of medicine use on 42 items divided over eight themes (see results); responses are rated on a five-point Likert scale to measure the extent of agreement (with 1 indicating strongly disagree and 5 indicating strongly agree).
Non-adherent patients were defined as those with proportion of day covered (PDC) <80%. Non-adherence was confirmed by a telephone contact. The study sample consisted of 196 participants, of whom 100 were adherent and 96 non-adherent, with a mean age of 71.0 years.
Overall, the mean LMQ-2 score (range 42-210) was 93.1 (SD: 13.6). In adherent participants it was 93.2 (SD: 13.3), and in non-adherent patients it was 93.0 (SD: 14.0). The LMQ-2 score did not differ significantly between adherent and non-adherent patients (P=0.931).
For individual items of the LMQ-2 questionnaire, the scores for the overall population for the different themes were:
- 19.8 (SD: 4.6) for patient-doctor relationships and communication about medicines (possible range 9-45, based on 9 items)
- 17.7 (SD: 4.4) for interferences with daily life (range 8-40)
- 13.3 (SD: 3.7) for practicalities (range 7-35)
- 8.9 (SD: 2.3) for effectiveness (range 4-20)
- 6.2 (SD: 1.8) for patient-pharmacist communication about medicines (range 3-15)
- 8.3 (SD: 2.7) for acceptance of medicine use (range 4-20)
- 12.8 (SD: 2.8) for autonomy/control over medicine use (4-20)
- 8.4 (SD: 2.7) for concerns about potential harm (range 3-15)
There were no significant differences between adherent and non-adherent patients.
Complex long-term therapies for CV diseases have an impact on various aspects of every-day life of patients, irrespectively of whether they adhere to their treatment regimens or not. The LMQ-2 answers indicated that patients experienced medication-related burden, particularly related to acceptance of long-term medicine use, medication-related concerns or dissatisfaction, the interference of medicines with social and daily lives, and the interaction and communication with health care workers. Health care providers should acknowledge this impact and make an effort to diminish patient’s medication-related burden by facilitating integration of long-term medication use in the daily lives of patients.