Analysis of adherence to therapy and compliance of outpatient treatment with the EURO FORTA system in elderly and senile polymorbid patients with CHF
Authors: Tarlovskaya E.I , Omarova J.V 
Published: October 2021

Abstract

Introduction
Chronic heart failure (CHF) is one of the main reasons for hospitalization in the elderly. Various scales and algorithms have been proposed to combat polypharmacy.

Purpose
To assess adherence to therapy and compliance of outpatient treatment with the EURO FORTA system.

Methods
The study included 313 patients admitted to the city center for the treatment of CHF from February 1, 2019 to October 1, 2020 at the age of 75±8.22 years. In all patients, the Charlson comorbidity index and the number of diseases (1–2, 3–5, &gt;5) were calculated. Outpatient treatment was assessed according to the EURO FORTA system (2018) in patients (over 65 years old – n=274, over 60 years old and ≥6 drugs – n=39) with CHF depending on the level of polymorbidity, age, sex, CHF variant and its severity. Heart failure was diagnosed in 66.77% of patients with preserved ejection fraction (EF), in 19.81% – with intermediate, in 13.42% - with low.

Results
Depending on the class of drugs according to the EURO FORTA system, 5 groups of patients were identified: 1st (received only class A drugs) – 3.51% of patients; 2nd (A, B)-22.36%; 3rd (A, B and C)-17.25%; 4th (A, B, C and D) – 27.17%; 5th – not taking medications on an outpatient basis 29.71%. In almost all groups at the outpatient stage, patients with&gt;5 diseases (pmg=0.020) prevailed (45.46–70.59%). At the outpatient stage in groups 1, 3 and 4 there were more patients with stage IIB CHF (63.64%, 51.86% and 47.06%) pmg=0.041, and in groups 2 and 5 – patients with stage IIA (58, 57% and 48.39%).
Class C: digoxin (n=4, patients with atrial fibrillation (AF) and CHF), amiodarone (n=3, patients with AF), moxonidine (n=1, patient with hypertension), betablockers 3 years after myocardial infarction (MI) (n=2), spironolactone (n=23, CHF). Reception of spironolactone on an outpatient basis was associated with a high risk of developing acute kidney injury (AKI) p=0.01, AKI in CKD p=0.042, and AF p=0.03.
Class D: non-steroidal anti-inflammatory drugs (NSAIDs) (n=68), aspirin for AF (n=2), class I-III antiarrhythmics (except amiodarone) (n=8), glibenclamide (n=1), nondihydropyridine calcium antagonists (n=2, patients with hypertension), dihydropyridine antagonists (n=1, with ischemic heart disease 3 years after MI). Taking NSAIDs on an outpatient basis was associated with a high risk of AKI development p=0.033, as well as anemia p=0.036, including grade 3 and 4 anemia (WHO) p=0.042.

Conclusion
Every second patient with CHF had more than 5 diseases. Every third person did not take drug therapy at the outpatient stage. The frequency of taking drugs of classes C and D was higher in polymorbid patients. With a more severe course of CHF, patients more often took class D drugs. Among class D were NSAIDs (80%) and class I-III antiarrhythmics (except amiodarone) (9.4%) prevailed. The use of spironolactone on an outpatient basis was associated with a high risk of AKI and AF, and NSAIDs-with AKI and anemia.

Funding Acknowledgement
Type of funding sources: None.