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European Journal of Heart Failure Advance Access originally published online on April 24, 2009
European Journal of Heart Failure 2009 11(7):715-720; doi:10.1093/eurjhf/hfp059
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org.

Adherence to angiotensin-converting-enzyme inhibitors and illness beliefs in older heart failure patients

Gerard J. Molloy1,*, Chuan Gao2, Derek W. Johnston2, Marie Johnston2, Miles D. Witham3, Allan D. Struthers4 and Marion E.T. McMurdo3

1 Department of Psychology, Cottrell Building, University of Stirling, Stirling FK9 4LA, UK
2 School of Psychology, University Aberdeen, Aberdeen AB24 2UB, UK
3 Ninewells Hospital and Medical School, Section Ageing and Health, University of Dundee, Dundee DD1 9SY, UK
4 Department of Clinical Pharmacology and Therapeutics, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK

* Corresponding author. Tel: +44 1786 46 7655, Fax: +44 1786 46 7641, Email: g.j.molloy{at}stir.ac.uk


  Abstract

Aims: Patient beliefs about heart failure (HF) may be important determinants of adherence. This study assessed levels of adherence to angiotensin-converting-enzyme inhibitors (ACEI) and examined whether beliefs about HF were associated with adherence to ACEI.

Methods and results: Fifty-eight patients with chronic stable HF (mean age 80.2 years SD ± 4.6, 43% female) were recruited from two outpatient clinics in Dundee, UK. The Illness Perception Questionnaire-Revised was used to assess beliefs about HF. Adherence to ACEI was assessed by measuring serum levels of angiotensin-converting enzyme (sACE). Adherence to ACEI (defined as sACE <5 U/L) was 72%. Beliefs about the time-line of HF and the consequences of HF accounted for 19% of the variability in adherence to ACEI in this sample. Heart failure patients who believed that their illness had a more chronic (longer term) time frame and had beliefs about the greater consequences of HF on their lives were less likely to adhere to ACEI.

Conclusion: Adherence to ACEI is sub-optimal. Beliefs about HF appear to be associated with objectively measured adherence to ACEI. Future studies should attempt to identify beliefs that consistently predict adherence and examine whether modifying these beliefs can increase adherence to HF medications.

Key Words: Adherence • Illness perceptions • Heart failure • Compliance • Self-management

Received December 18, 2008; Revised March 4, 2009; Accepted March 24, 2009


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