Abstract Body: Background
Research suggests that only ~50% of patients with HF meet recommended medication adherence; rates of overall treatment adherence, which additionally includes lifestyle changes and cardiac rehabilitation attendance, are even lower. Drivers of treatment nonadherence in this population remain poorly understood. This qualitative study aims to identify barriers and facilitators of treatment adherence among patients with HF.
Methods
We recruited 19 adult patients with a diagnosis of HF from 2 clinics in Kentucky to participate in interviews. All patients had access to a phone to facilitate the interview and were free of genetic heart conditions. Treatment adherence was defined as a patient’s ability to follow the recommended treatment prescribed by their healthcare provider. A semi-structured interview guide was used to ask patients about experiences, habits, barriers, and facilitators to engaging in their HF treatment. Six patients participated in follow-up interviews to assess the study team’s interpretation of their prior responses and to ask clarifying questions to ensure saliency of the findings.
Results
Over half of the participants identified physician communication as crucial to their experience, specifically: open dialog, honest explanations of treatment side effects, and willingness to listen. Many patients identified goal setting as critical to their treatment adherence, especially after initial diagnosis. By setting small, obtainable goals with their medical team, patients described feelings of increased self-confidence and reported making positive lifestyle changes. Rising cost of medication, food, and other therapies were identified as adherence barriers. Finally, 42% of patients discussed having significant fear regarding their HF diagnosis which began after a precipitating traumatic event, such as a hospitalization or heart attack, and persisted years later. However, some patients found this fear to be a motivation to make and maintain lifestyle changes. Several patients also expressed feelings of depression or isolation resulting from reduced autonomy.
Conclusion
These qualitative findings suggest that patients are more likely to engage with their treatment plan when they have effective communication with their physician, set obtainable goals, and are able to afford both food and medication. Interventions to improve outcomes for patients with HF should focus on the patient-doctor relationship and connection to available financial resources.