Frequency and Factors Leading to Non-Adherence to SGLT-2 Inhibitors in Patients with Ischemic Heart Disease
DOI:
https://doi.org/10.70749/ijbr.v2i02.411Keywords:
SGLT-2 Inhibitors, Non-adherence, Ischemic Heart Disease, Patient Education, Side EffectsAbstract
Objective: To evaluate the frequency of non-adherence to sodium-glucose cotransporter-2 (SGLT-2) inhibitors in patients with ischemic heart disease (IHD) and identify factors contributing to non-adherence at National Institute of Cardiovascular Diseases Karachi, Pakistan. Methodology: A prospective descriptive study was conducted on 171 IHD patients prescribed SGLT-2 inhibitors at the National Institute of Cardiovascular Diseases, Karachi. Adherence was assessed using the MMAS-8© scoring system, categorizing patients into high adherence (score = 8), medium adherence (score 6–7), and low-adherence (score < 6), we will take a score of <6 as Non-adherence. Factors influencing adherence, including patient education about SGLT2 inhibitors, side effects, and cost, were analyzed. Statistical analysis was performed using chi-square tests with a significance level of P ≤ 0.05. Results: Among 171 patients, 58 (33.91%) demonstrated high adherence, 42 (24.56%) had medium adherence, and 71 (41.53%) were non-adherent (P = 0.003). The primary factors influencing non-adherence included lack of patient education (24 patients, 14.03%, P = 0.001), side effects (19 patients, 11.11%, P = 0.001), and cost barriers (15 patients, 8.77%, P = 0.001). Dizziness was the most frequently reported side effect (12 patients, 63.16%). Conclusion: The study highlights significant non-adherence to SGLT-2 inhibitors, driven by education gaps, side effects, and cost issues. Addressing these factors through patient education about SGLT2 inhibitors, affordable access programs, and proactive side effect management can enhance adherence and improve cardiovascular outcomes in IHD patients.
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Malik, M., Falkentoft, A., Jensen, J., Andersson, C., Parveen, S. L., Koeber, L., & Schou, M. E. M. (2022). Adherence and discontinuation of sglt2-inhibitors and glp1-r agonists in patients with type 2 diabetes with and without cardiovascular disease. European Heart Journal, 43(Supplement_2). https://doi.org/10.1093/eurheartj/ehac544.2692
Kono, S., Moon, J., Chong, A., Fang, J., Ko, D. T., Austin, P., Atzema, C., Naimark, D., Udell, J. A., Stukel, T., Tu, K., Booth, G., & Jackevicius, C. (2023). Abstract 15684: Adherence and Persistence to SGLT2 Inhibitors in Patients With Heart Failure. Circulation, 148(Suppl_1). https://doi.org/10.1161/circ.148.suppl_1.15684
Khartabil, N., Morello, C. M., & Macedo, E. (2024). Predictive Modeling of Factors Influencing Adherence to SGLT-2 Inhibitors in Ambulatory Care: Insights from Prescription Claims Data Analysis. Pharmacy, 12(2), 72–72. https://doi.org/10.3390/pharmacy12020072
Cowie, M. R., & Fisher, M. (2020). SGLT2 inhibitors: mechanisms of cardiovascular benefit beyond glycaemic control. Nature Reviews Cardiology, 17(12), 761–772. https://doi.org/10.1038/s41569-020-0406-8
Saad, M., Mahmoud, A. N., Elgendy, I. Y., Abuzaid, A., Barakat, A. F., Elgendy, A. Y., Al-Ani, M., Mentias, A., Nairooz, R., Bavry, A. A., & Mukherjee, D. (2017). Cardiovascular outcomes with sodium–glucose cotransporter-2 inhibitors in patients with type II diabetes mellitus: A meta-analysis of placebo-controlled randomized trials. International Journal of Cardiology, 228, 352–358. https://doi.org/10.1016/j.ijcard.2016.11.181
Lopaschuk, G. D., & Verma, S. (2020). Mechanisms of Cardiovascular Benefits of Sodium Glucose Co-Transporter 2 (SGLT2) Inhibitors. JACC: Basic to Translational Science, 5(6), 632–644. https://doi.org/10.1016/j.jacbts.2020.02.004
Li, X., Zhang, Q., Zhu, L., Wang, G., Ge, P., Hu, A., & Sun, X. (2021). Effects of SGLT2 inhibitors on cardiovascular, renal, and major safety outcomes in heart failure: A meta-analysis of randomized controlled trials. International Journal of Cardiology, 332, 119–126. https://doi.org/10.1016/j.ijcard.2021.03.077
Treewaree, S., Kulthamrongsri, N., Owattanapanich, W., & Krittayaphong, R. (2023). Is it time for class I recommendation for sodium-glucose cotransporter-2 inhibitors in heart failure with mildly reduced or preserved ejection fraction?: An updated systematic review and meta-analysis. Frontiers in Cardiovascular Medicine, 10. https://doi.org/10.3389/fcvm.2023.1046194
Fatima, A., Rasool, S., Devi, S., Talha, M., Waqar, F., Nasir, M., Khan, M. R., Jaffari, S. M. I. A., Haider, A., Shah, S. U., Sapna, F. N. U., Varrassi, G., Khatri, M., Kumar, S., Mohamad, T., Fatima, A., Rasool, S., Devi, S., Talha, M., & Waqar, F. (2023). Exploring the Cardiovascular Benefits of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors: Expanding Horizons Beyond Diabetes Management. Cureus, 15(9). https://doi.org/10.7759/cureus.46243
Verma, S. (2019). Potential Mechanisms of Sodium-Glucose Co-Transporter 2 Inhibitor-Related Cardiovascular Benefits. The American Journal of Cardiology, 124, S36–S44. https://doi.org/10.1016/j.amjcard.2019.10.028
Mohebi, R., & Januzzi, J. L. (2021). Cardiovascular benefit of SGLT2 inhibitors. Critical Reviews in Clinical Laboratory Sciences, 59, 1–14. https://doi.org/10.1080/10408363.2021.1993439
Khan, M. S. (2021). SGLT2 inhibitors: A revolution in therapeutics of a major Non-Communicable Disease. Journal of the Pakistan Medical Association, 1–3. https://doi.org/10.47391/jpma.1192
Owais, M., Ghulam, N., Yaqoob, N. Y., xMusharaf, M., Wahid, N. A., & x Izat, M. (2024). Role of SGLT2 inhibitors in improving cardiac functions (on Echocardiography) in patients having Diabetes Mellitus and ischemic heart disease. Journal of University Medical & Dental College, 15(3). https://doi.org/10.37723/jumdc.v15i3.942
Sinha, T., Khilji, F., Laraib, F., Fatima, F., Kaur, M., Chaudhari, S. S., Arrey Agbor, D. B., & Khan, A. (2024). The Effectiveness of Sodium-Glucose Cotransporter-2 (SGLT2) Inhibitors on Cardiovascular Outcomes and All-Cause Mortality in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. Cureus. https://doi.org/10.7759/cureus.58019
Graversen, C., Valentin, J., Larsen, M., Riahi, S., Holmberg, T., Zinckernagel, L., & Johnsen, S. (2021). Lower perception of pharmacological treatment increases risk of non-adherence to medication. European Journal of Preventive Cardiology, 28(Supplement_1). https://doi.org/10.1093/eurjpc/zwab061.258
Alamgir, M. (2023). Improved treatment for diabetes type 2 associated heart failure. Journal of Pakistan Medical Association, 73(9), 1934–1935. https://doi.org/10.47391/jpma.8085
Ala, M. (2021). SGLT2 inhibition for cardiovascular diseases, chronic kidney disease and NAFLD. Endocrinology. https://doi.org/10.1210/endocr/bqab157
Denicolò, S., Perco, P., Thöni, S., & Mayer, G. (2021). Non-adherence to antidiabetic and cardiovascular drugs in type 2 diabetes mellitus and its association with renal and cardiovascular outcomes: A narrative review. Journal of Diabetes and Its Complications, 35(7), 107931. https://doi.org/10.1016/j.jdiacomp.2021.107931
Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., Mattheus, M., Devins, T., Johansen, O. E., Woerle, H. J., Broedl, U. C., & Inzucchi, S. E. (2015). Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. New England Journal of Medicine, 373(22), 2117–2128. https://doi.org/10.1056/nejmoa1504720
Neal, B., Perkovic, V., Mahaffey, K. W., de Zeeuw, D., Fulcher, G., Erondu, N., Shaw, W., Law, G., Desai, M., & Matthews, D. R. (2017). Canagliflozin and Cardiovascular and Renal Events in Type 2 Diabetes. New England Journal of Medicine, 377(7), 644–657. https://doi.org/10.1056/nejmoa1611925
Taibanguay, N., Chaiamnuay, S., Asavatanabodee, P., & Narongroeknawin, P. (2019). Effect of Patient Education on Medication Adherence of Patients with Rheumatoid arthritis: a Randomized Controlled Trial. Patient Preference and Adherence, 13(1), 119–129. https://doi.org/10.2147/ppa.s192008
Perkovic, V., Jardine, M. J., Neal, B., Bompoint, S., Heerspink, H. J. L., Charytan, D. M., Edwards, R., Agarwal, R., Bakris, G., Bull, S., Cannon, C. P., Capuano, G., Chu, P.-L., de Zeeuw, D., Greene, T., Levin, A., Pollock, C., Wheeler, D. C., Yavin, Y., & Zhang, H. (2019). Canagliflozin and Renal Outcomes in Type 2 Diabetes and Nephropathy. New England Journal of Medicine, 380(24), 2295–2306. https://doi.org/10.1056/nejmoa1811744
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