JAMA Netw Open. 2024 Dec 2;7(12):e2453976. doi: 10.1001/jamanetworkopen.2024.53976.
ABSTRACT
IMPORTANCE: Poor medication adherence is associated with high morbidity and mortality among patients with chronic heart failure (CHF), which is particularly concerning in China.
OBJECTIVE: To assess the effect of a pharmacist-led management model incorporating a social media platform vs usual care on medication adherence in patients with CHF.
DESIGN, SETTING, AND PARTICIPANTS: This prospective, multicenter randomized clinical trial was conducted from March 2021 to May 2023, with a follow-up duration of 52 weeks. The trial was conducted in the cardiology wards of 5 hospitals in China. Participants were 18 years or older, had a CHF diagnosis, and were receiving stable medication. They were randomly assigned to either the intervention group (pharmacist-led management) or the control group (usual care) in a 1:1 ratio using a computer-generated random number table with concealed allocation via opaque envelopes. Intention-to-treat data analysis was performed from June 2023 to July 2024.
INTERVENTION: The intervention group received a multimodal pharmaceutical intervention, including WeChat application-based communication and education, and a standardized follow-up visit from a pharmacist every month. The control group received the standardized follow-up visit from nurses every month.
MAIN OUTCOMES AND MEASURES: The primary outcome was the proportion of days covered (PDC) by heart failure medication at 52 weeks.
RESULTS: Among the 445 participants analyzed, 223 were assigned to the intervention group and 222 to the control group. These patients had a mean (SD) age of 63.2 (13.3) years and included 263 males (59.1%). A total of 333 patients (74.8%) had a New York Heart Association class III or IV heart failure, indicating severe limitations in physical activity. At 52 weeks, the intervention group had a significantly higher PDC for heart failure medication (8.1%; 95% CI, 5.5%-10.7%; P < .001) and a greater proportion of patients with PDC of 80% or greater (odds ratio, 0.34; 95% CI, 0.21-0.54; P < .001) compared with the control group.
CONCLUSIONS AND RELEVANCE: This randomized clinical trial found a modest improvement in medication adherence among patients with CHF who received the pharmacist-led management intervention vs usual care.
TRIAL REGISTRATION: Chinese Clinical Trial Registry Identifier: ChiCTR2000040232.
PMID:39705029 | DOI:10.1001/jamanetworkopen.2024.53976
