Adherence to treatment in patients with heart failure with preserved left ventricular ejection fraction: an observational study based on a city outpatient clinic
https://doi.org/10.15829/1728-8800-2025-4422
EDN: WHLHJP
Abstract
Aim. To assess the clinical features and adherence to treatment in outpatients with heart failure with preserved left ventricular ejection fraction (HFpEF).
Material and methods. This cross-sectional observational study was conducted based on a city outpatient clinic involving 230 patients >60 years old with HFpEF. Adherence to therapy was assessed using the National Society for Evidence-Based Pharmacotherapy scale.
Results. The mean age of the subjects was 74 years (women, 60,4%). Multimorbidity was recorded in 99,1% of patients, while the most common comorbidities were hypertension (97,4%), coronary artery disease (65,7%) and obesity (39,1%). Most patients (57%) belonged to New York Heart Association (NYHA) functional class II. The median value of the left ventricular ejection fraction was 64%; 60% of respondents took ≥5 drugs. The level of complete adherence to therapy (0 points) was demonstrated by 77,8% of patients. Among the reasons for incomplete adherence (≥1 point), forgetfulness dominated (54,9%), followed by doubts on the need for therapy (15,7%) and complexity of the treatment regimen (11,8%).
Conclusion. Despite the high level of complete adherence to treatment found in the majority of patients with HFpEF, 22,2% demonstrated various violations of the drug treatment regimen, which requires close attention from outpatient physicians.
About the Authors
V. N. Larina
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Moscow
K. A. Zamyatin
Pirogov Russian National Research Medical University
Russian Federation
Russian Federation
Moscow
References
1. Drapkina OM, Boytsov SA, Omelyanovskiy VV, et al. Socioeconomic impact of heart failure in Russia. Russian Journal of Cardiology. 2021;26(6):4490. (In Russ.) doi:10.15829/1560-4071-2021-4490.
2. Savarese G, Becher PM, Lund LH, et al. Global burden of heart failure: a comprehensive and updated review of epidemiology. Cardiovasc Res. 2023;118(17):3272-87. doi:10.1093/cvr/cvac013.
3. Pfeffer MA, Shah AM, Borlaug BA. Heart Failure With Preserved Ejection Fraction In Perspective. Circ Res. 2019;124(11):1598-617. doi:10.1161/CIRCRESAHA.119.313572.
4. Smirnova EA, Ponomareva OV, Skiperskikh PV, et al. Clinical and phenotypical profiles of patients with chronic heart failure with preserved ejection fraction. The Russian Journal of Preventive Medicine. 2025;28(1):83-8. (In Russ.) doi:10.17116/profmed20252801183.
5. Galochkin SA, Bagmanova NKh, Kazakhmedov ER, et al. Decompensation triggers of various phenotypes of chronic heart failure. Clin Pharmacol Ther. 2020;29(3):37-43. (In Russ.) doi:10.32756/0869-5490-2020-3-37-43.
6. Omarova YuV, Tarlovskaya EI, Mordvinov AA. Adherence to therapy in polymorbid patients with chronic heart failure. Eruditio Juvenium. 2022;10(1):45-52. (In Russ.) doi:10.23888/HMJ202210145-52.
7. Ageev FT, Ovchinnikov AG. Diastolic heart failure: 20 years later. Сurrent issues of pathogenesis, diagnosis and treatment of heart failure with preserved LVEF. Kardiologiia. 2023;63(3):3-12. (In Russ.) doi:10.18087/cardio.2023.3.n2376.
8. Vinogradova NG, Polyakov DS, Fomin IV. The risks of re-hospitalization of patients with heart failure with prolonged followup in a specialized center for the treatment of heart failure and in real clinical practice. Kardiologiia. 2020;60(3):59-69. (In Russ.) doi:10.18087/cardio.2020.3.n1002.
9. Larina VN, Skiba IK. Prospects for predicting and preventing the heart failure deterioration: an analytical review. Russian Journal of Cardiology. 2024;29(9):5854. (In Russ.) doi:10.15829/1560-4071-2024-5854. EDN: NLOUYV.
10. Metra M, Tomasoni D, Adamo M, et al. Worsening of chronic heart failure: definition, epidemiology, management and prevention. A clinical consensus statement by the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2023; 25(6):776-91. doi:10.1002/ejhf.2874.
11. Drapkina OM, Chesnikova AI. Principles of Outpatient Care of Patients With Heart Failure. Kardiologiia. 2024;64(11):148-56. (In Russ.) doi:10.18087/cardio.2024.11.n2797.
12. Lukina YuV, Kutishenko NP, Martsevich SYu, et al. Problematic issues and development of classifications of the main parameters of quality and adherence to pharmacotherapy. Part I: Patient adherence to treatment. Cardiovascular Therapy and Prevention. 2023;22(6):3603. (In Russ.) doi:10.15829/1728-8800-2023-3603. EDN: FIPSNA.
13. Soltani F, Lewis GA, Rosala-Hallas A, et al. Treatment Adherence in a Randomized Controlled Trial of Pirfenidone in HFpEF: Determinants and Impact on Efficacy. J Card Fail. 2023;29(7):1091-6. doi:10.1016/j.cardfail.2023.02.010.
14. Jarrah M, Khader Y, Alkouri O, et al. Medication Adherence and Its Influencing Factors among Patients with Heart Failure: A Cross Sectional Study. Medicina (Kaunas). 2023;59(5):960. Published 2023. doi:10.3390/medicina59050960.
15. Larina VN, Zamyatin KA, Gudiev ChG. Medication adherence in patients with heart failure: a pilot observational study in outpatient practice. Russian Journal of Cardiology. 2024;29(12S):6180. (In Russ.) doi:10.15829/1560-4071-2024-6180. EDN: OBICSP.
16. Galyavich AS, Tereshchenko SN, Uskach TM, et al. 2024 Clinical practice guidelines for Chronic heart failure. Russian Journal of Cardiology. 2024;29(11):6162. (In Russ.) doi:10.15829/1560-4071-2024-6162. EDN: WKIDLJ.
17. Mareev VYu, Fomin IV, Ageev FT, et al. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiia. 2018;58(6S):8-158. (In Russ.) doi:10.18087/cardio.2475.
18. Lukina YuV, Kutishenko NP, Martsevich SYu, et al. The Questionnaire Survey Method in Medicine on the Example of Treatment Adherence Scales. Rational Pharmacotherapy in Cardiology. 2021;17(4):576-83. (In Russ.) doi:10.20996/1819-6446-2021-08-02.
19. Hamo CE, DeJong C, Hartshorne-Evans N, et al. Heart failure with preserved ejection fraction. Nat Rev Dis Primers. 2024;10(1):55. doi:10.1038/s41572-024-00540-y.
20. Vergaro G, Ghionzoli N, Innocenti L, et al. Noncardiac Versus Cardiac Mortality in Heart Failure With Preserved, Midrange, and Reduced Ejection Fraction. J Am Heart Assoc. 2019;8(20): e013441. doi:10.1161/JAHA.119.013441.
21. Groenewegen A, Rutten FH, Mosterd A, et al. Epidemiology of heart failure. Eur J Heart Fail. 2020;22(8):1342-56. doi:10.1002/ejhf.1858.
22. Guseynova ET, Lukina YuV, Kutishenko NP, et al. Problem and factors of patients with chronic heart failure treatment compliance according to outpatient registry. Russian Journal of Preventive Medicine. 2023;26(11):39-44. (In Russ.) doi:10.17116/profmed20232611139.
23. Volkova SYu, Alyokhina MN, Boyarskaya EA. Assessment of psychemotional risk factors affecting adherence to therapy in patients with chronic heart failure in outpatient setting. Medical science and education of Ural. 2023;24(1):22-6. (In Russ.) doi:10.36361/18148999_2023_24_1_22.
24. Lukina YuV, Kutishenko NP, Martsevich SYu, et al. Questionnaires and scores for assessing medication adherence — advantages and disadvantages of the diagnostic method in research and actual clinical practice. Cardiovascular Therapy and Prevention. 2020;19(3):2562. (In Russ.) doi:10.15829/1728-8800-2020-2562.
25. Bunova SS, Zhernakova NI, Skirdenko YuP, et al. Adherence to therapy, lifestyle modification and medical support of cardiovascular patients. Cardiovascular Therapy and Prevention. 2020;19(6):2665. (In Russ.) doi:10.15829/1728-8800-2020-2665.
26. Nikolaev NA, Martynov AI, Skirdenko YuP, et al. International Declaration of Adherence to Treatment 2023 ("Omsk Declaration"): Presentation for Russian readers. Medical News of North Caucasus. 2024;19(1):1-9. (In Russ.) doi:10.14300/mnnc.2024.19001.
Supplementary files
What is already known about the subject?
- High-quality outpatient care for patients with heart failure with preserved ejection fraction can significantly improve the course of the disease and prognosis.
- Complete adherence of patients to drug therapy is the most important condition for its effectiveness.
What might this study add?
- More than half (60%) of patients with heart failure with preserved ejection fraction took ≥5 medications.
- Almost a quarter (22,2%) of all patients included in the study violated the drug regimen prescribed by the physician.
- The main reasons for incomplete adherence to treatment were forgetfulness and insufficient medical awareness of patients.
Review
For citations:
Larina V.N., Zamyatin K.A. Adherence to treatment in patients with heart failure with preserved left ventricular ejection fraction: an observational study based on a city outpatient clinic. Cardiovascular Therapy and Prevention. 2025;24(6):4422. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4422. EDN: WHLHJP
Views:
82
Email this article 
