Treatment of chronic heart failure in adults at a referral hospital in Kenya: adverse drug reactions and determinants of adherence

Abstract

Background: Chronic Heart Failure is a major health problem with a prevalence of between 1 and 12% in USA and Europe, and approximately 5.7% in Sub-Saharan Africa, and has socio-economic relevance owing to its high prevalence, mortality and impact on young economically active individuals. In 1999 chronic heart failure constituted 3.3% of all medical admissions at Kenyatta National Hospital.

Objective: The purpose of the current study was to determine factors that affect adherence to treatment among patients with Chronic Heart Failure at Kenyatta National Hospital and assess any association between any such factors

Methodology: This was a descriptive cross-sectional study involving patients >18 years diagnosed with Chronic Heart Failure at Kenyatta National Hospital. Eighty three eligible and consenting study participants were recruited into the study using a convenient sampling technique. Data were collected by means of an interviewer administered questionnaire adapted from the Revised HF Adherence Questionnaire.

Results: Data from 83 patients was analyzed majority (n=51, 61.4%) of whom were women. The age of the patients ranged from 18 to 80 years with the majority (n= 37, 44.6%), between 21-40 years. Majority (n=58, 68.9%) of the patients considered appointment keeping, compliance to medication (n= 64, 77.1%), dietary restriction (n=59, 72%), regular exercise (n=49 59.0%), smoking cessation (n=59, 71%), and alcohol cessation (n=58, 69.9%) as very important. Fifty three (63.9%) respondents had not failed to take their medicines at any time.  Majority (n=72, 86.8%) of the study participants were aware of the disease condition they were suffering from while valvular heart disease was the commonest comorbidity (n= 17 27.9%). The study revealed an association between sex and some adverse drug reactions using Pearson χ² test through bivariate analysis. Sleep disturbances and nausea occurred more in males than females while headache and drowsiness were more prevalent in females and in both cases the relationships were statistically significant (p< 0.05)

Conclusions: Adherence to medicines among patients with Chronic Heart Failure is reasonably high at Kenyatta National Hospital despite patients’ knowledge level about the condition being generally low. Valvular heart disease was the most common comorbidity while hyponatremia was the most prevalent electrolyte disturbance, and tachycardia, vomiting and rash the most common adverse drug effects.

Key words

Chronic heart failure; adherence; compliance; adverse drug reactions.