Pharmaceutical guidance and the impact on medication adherence in patients with amyloidosis

Authors

DOI:

https://doi.org/10.30968/rbfhss.2024.152.1101

Abstract

Objectives: To identify medication adherence in patients with Cardiac Amyloidosis (CA) before and after pharmaceutical guidance and investigate its association with quality of life. Methods: This is a before-and-after, single-arm, non-randomized study. The selection was among patients with transthyretin (TTR) cardiac amyloidosis included in research protocols of the Instituto do Coração do Complexo do Hospital das Clínicas da Universidade de São Paulo (InCor HCFMUSP). Five pharmaceutical visits were performed, the first in person and the others by telehealth. The Kansas City Cardiomyopathy Questionnaire (KCCQ) and Brief Medication Questionnaire (BMQ) quality of life questionnaires were used. Medication adherence was identified and classified into four categories: adherent, probable adherent, probable low adherent, and low adherent. To estimate the association between medication adherence and quality of life, analysis was performed using ANOVA and unpaired t-test. Results: 11 participants agreed to participate in all study visits. Mean age was 74.2 years (SD= 8.4), 95.2% were male, and 47.6% had completed college education. The mean number of medications in use was 8 (dp= 2.9). 54.5% of participants were classified as adherent. The association between medication adherence and quality of life was significant for the Total Symptom Score and Clinical Summary domains. There was no significance in the correlations between the number of medications and KCCQ. Conclusions: Pharmacotherapy follow-up mediated by telehealth for patients with Cardiac Amyloidosis can improve in at least one domain of KCCQ.

Downloads

Download data is not yet available.

References

Fontana M, Banypersad SM, Treibel TA, et al. Differential myocyte responses in patients with cardiac transthyretin amyloidosis and light-chain amyloidosis: A cardiac MR imaging study. Radiol. 2015; 277(2):388–97. DOI: 10.1148.

Martinez-Naharro A, Hawkins PN, Fontana M. Cardiac amyloidosis. Clin Med J R Coll Physicians London. 2018; 18(Suppl 2):s30–5. DOI: 10.7861.

González-López E, Gallego-Delgado M, Guzzo-Merello G, et al. Wild-type transthyretin amyloidosis as a cause of heart failure with preserved ejection fraction. Eur Heart J. 2015; 36(38):2585–94. DOI: 10.1093.

Bhogal S, Ladia V, Sitwala P, et al Amyloidosis. Cardiac: An Updated Review With Emphasis on Diagnosis and Future Directions. Curr Probl Cardiol. 2018; 43(1):10–34. DOI: 10.1016.

Galant NJ, Westermark P, Higaki JN, et al. Transthyretin amyloidosis: An under-recognized neuropathy and cardiomyopathy. Clin Sci. 2017; 131(5):395–409. DOI: 10.1042.

Lousada I, Comenzo RL, Landau H, et al. Light Chain Amyloidosis: Patient Experience Survey from the Amyloidosis Research Consortium. Adv Ther. 2015; 32(10):920–8. DOI: 10.1007.

Aimo A, Rapezzi C, Perfetto F, et al. Quality of life assessment in amyloid transthyretin (ATTR) amyloidosis. Eur J Clin Invest. 2021; 51(11):e13598. DOI: 10.1111.

Vergaro G, Aimo A, Barison A, et al. Keys to early diagnosis of cardiac amyloidosis: red flags from clinical, laboratory and imaging findings. Eur J Prev Cardiol. 2020; 27(17):1806–15. DOI: 10.1177.

Oliveira TL, Santos CM, Miranda L de P, et al. Fatores associados ao custo das internações hospitalares por doenças sensíveis à Atenção Primária no Sistema Único de Saúde. Cien Saude Colet. 2021; 26(10):4541–52. DOI: 10.1590.

Alexander KM, Witteles RM. Management of Cardiac Amyloidosis: Do’s and Don’ts. Can J Cardiol. 2020; 36(3):444–6. DOI: 10.1016.

Brasil. Ministério da Saúde. Relatório para a Sociedade: Tafamidis meglumina no tratamento de pacientes com cardiomiopatia Amiloide associada à transtirretina (selvagem ou hereditária) acima de 60 anos de idade. Conitec, 2020.

Masciarelli Pinto I, Poggio Smanio PE, de Andrade Vilela A, et al. Amiloidose Cardíaca: Ainda Uma Doença Rara? Rev da Soc Cardiol do Estado São Paulo. 2021; 31(2):187–97. DOI: 10.29381.

Garcia-Pavia P, Rapezzi C, Adler Y, et al. Diagnosis and treatment of cardiac amyloidosis: A position statement of the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2021; 42(16):1554–68. DOI: 10.1093

Gertz MA, Dispenzieri A. Systemic Amyloidosis Recognition, Prognosis, and Therapy: A Systematic Review. JAMA - J Am Med Assoc. 2020; 324(1):79. DOI: 10.1001.

Muchtar E, Dispenzieri A, Magen H, et al. Systemic amyloidosis from A (AA) to T (ATTR): a review. J Intern Med. 2021; 289(3):268–92. DOI: 10.1111.

Ministério da Saúde. Organização Pan-Americana da Saúde. Envelhecimento ativo: uma política de saúde. Brasília (DF): OPAS 2005.

Conselho Federal de Farmácia. Resolução CFF nº 585, de 29 de Agosto de 2013. Regulamenta as atribuições clínicas do farmacêutico e dá outras providências. Diário Oficial da União, v. 29, 2013.

Conselho Federal de Farmácia (CFF). Serviços Farmacêuticos diretamente destinados ao paciente, à família e à comunidade: contextualização e arcabouço conceitual. Brasília: Conselho Federal de Farmácia, v. 200, 2016.

Silva NA, Dos Santos JF, Jacomassi E, et al. Adesão ao tratamento em doenças crônicas: instrumentos utilizados para avaliação. Braz J Surg Clin Research. 2020; 32(2): 125-130.

Brasil. Ministério da Saúde. Secretaria-Executiva. Departamento de Informática do SUS. Estratégia de Saúde Digital para o Brasil 2020-2028 [recurso eletrônico] / Ministério da Saúde, Secretaria-Executiva, Departamento de Informática do SUS. – Brasília : Ministério da Saúde, 2020. 128 p.

Conselho Federal de Farmácia (CFF). Resolução nº 727, de 30 de Junho de 2022. Dispõe sobre a regulamentação da Telefarmácia. Brasília.

Oscalices MIL, Okuno MFP, Lopes MCBT, et al. Health literacy and adherence to treatment of patients with heart failure. Rev da Esc Enferm. 2019; 53. DOI: 10.1590.

Pfizer. Safety and efficacy of tafamidis in patients with transthyretin cardiomyopathy (ATTR-ACT).

Maurer MS, Schwartz JH, Gundapaneni B, et al. Tafamidis Treatment for Patients with Transthyretin Amyloid Cardiomyopathy. N Engl J Med. 2018; 379(11):1007–16. DOI: 10.1056.

Câmara de Regulação de Medicamentos (CMED). Preços máximos de medicamentos por princípio ativo. 2023.

BRASIL. Ministério da saúde. Portaria SCTIE/MS nº 177, de 21 de dezembro de 2022. Torna pública a decisão de não incorporar, no âmbito do Sistema Único de Saúde - SUS, o tafamidis meglumina no tratamento de pacientes com cardiomiopatia amiloide associada à transtirretina (selvagem ou hereditária), classes NYHA II e III acima de 60 anos de idade. Diário Oficial da República Federativa do Brasil. Brasília, dez. 2022.

Chen C, Liu GG, Shi QL, et al. Health-Related Quality of Life and Associated Factors Among Oldest-Old in China. J Nutr Heal Aging. 2020; 24(3):330–8. DOI: 10.1007.

Chisholm-Burns MA, Kim Lee J, Spivey CA, et al. US pharmacists’ effect as team members on patient care: Systematic review and meta-analyses. Med Care. 2010; 48(10):923–33. DOI: 10.1097.

Mohammed MA, Moles RJ, Chen TF. Impact of Pharmaceutical Care Interventions on Health-Related Quality-of-Life Outcomes: A Systematic Review and Meta-analysis. Ann Pharmacother. 2016; 50(10):862–81. DOI: 10.1177.

Parajuli DR, Franzon J, McKinnon RA, et al. Role of the Pharmacist for Improving Self-care and Outcomes in Heart Failure. Curr Heart Fail Rep. 2017; 14(2):78–86. DOI: 10.1007.

Velázquez Fuentes MN, Shah P, Hale GM. Improving medication adherence in patients with hypertension through pharmacist-led telehealth services. J Telemed Telecare. 2022; 28(8):613–7. DOI: 10.1177.

Niznik JD, Harvey HE; Kane-Gill SL. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: a systematic review. Res Social Adm Pharm. 2018; 14(8): 707-717. DOI: 10.1016.

Maldonado JMS de V, Marques AB, Cruz A. Telemedicine: challenges to dissemination in Brazil. Cad Saude Publica. 2016; 32(suppl 2). DOI: 10.1590.

Saade DCM. Telemedicina no Brasil: Nova Regulamentação Incentiva Pesquisa e Inovação em Soluções Seguras para Saúde Digital. J Health Inform. 2019; 11(1).

Tan NY, Mohsin Y, Hodge DO, et al. Catheter Ablation for Atrial Arrhythmias in Patients With Cardiac Amyloidosis. J Cardiovasc Electrophysiol. 2016; 27(10):1167–73. DOI: 10.1111.

Yamamoto H, Yokochi T. Transthyretin cardiac amyloidosis: an update on diagnosis and treatment. ESC Hear Fail. 2019;6(6):1128–39. DOI: 10.1002.

El-Am EA, Dispenzieri A, Melduni RM, et al. Direct Current Cardioversion of Atrial Arrhythmias in Adults With Cardiac Amyloidosis. J Am Coll Cardiol. 2019; 73(5):589–97. DOI:10.1016.

Feng DL, Edwards WD, Oh JK, et al. Intracardiac thrombosis and embolism in patients with cardiac amyloidosis. Circulation. 2007; 116(21):2420–6. DOI: 10.1161.

Kittleson MM, Maurer MS, Ambardekar AV, et al. Cardiac Amyloidosis: Evolving Diagnosis and Management: A Scientific Statement from the American Heart Association. Circulation. 2020; 142(1):E7–22. DOI: 10.1161.

Gillmore JD, Damy T, Fontana M, et al. A new staging systemfor cardiac transthyretin amyloidosis. Eur Heart J. 2018; 39(30):2799–806. DOI: 10.1093.

Ben A.J. Confiabilidade e Análise de Desempenho de Dois Questionários de Avaliação da Adesão ao Tratamento Anti-hipertensivo: Teste de Morisky-Green e Brief Medication Questionnaire [Dissertação Mestrado]. Universidade Federal do Rio Grande do Sul, Porto Alegre, 2011.

Svarstad BL, Chewning BA, Sleath BL, et al. The brief medication questionnaire: A tool for screening patient adherence and barriers to adherence. Patient Educ Couns. 1999; 37(2):113–24. DOI: 10.1016.

Nave-Leal E, Pais-Ribeiro J, Oliveira MM, et al. Propriedades psicométricas da versão portuguesa do Kansas City Cardiomyopathy Questionnaire na miocardiopatia dilatada com insuficiência cardíac a congestiva. Rev Port Cardiol. 2010; 29(3):353–72.

Green CP, Porter CB, Bresnahan DR, et al. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire: a new health status measure for heart failure. J Am Coll Cardiol. 2000; 35(5):1245-55.

Published

2024-06-29

How to Cite

1.
EVANGELISTA A, GALANTE MC, CIPRIANO SL, FERNANDES F. Pharmaceutical guidance and the impact on medication adherence in patients with amyloidosis. Rev Bras Farm Hosp Serv Saude [Internet]. 2024Jun.29 [cited 2024Jul.20];15(2):e1101. Available from: https://rbfhss.org.br/sbrafh/article/view/1101

Issue

Section

ORIGINAL ARTICLES

Most read articles by the same author(s)