Polypharmacy, therapeutic inertia, and adherence of heart recipients to drug therapy

Heart transplantation remains the gold standard treatment for end-stage heart failure. Lifelong immunosuppressive and adjuvant therapy requires constant medical follow-up in order to optimize treatment regimens and increase the adherence of heart recipients to treatment.

Objective: to study and adapt a method for systematic assessment of the complexity of treatment regimen using the MRCI index, and its link to long-term prognosis in heart recipients.

Materials and methods. Results of the study were obtained by analyzing the data of heart recipients observed at the Consultative & Diagnostic Department, Shumakov National Medical Research Center of Transplantology and Artificial Organs (Shumakov Center). The Medication Regimen Complexity Index (MRCI) was used to assess drug therapy. In our study, polypharmacy was defined as taking five or more medications, and high-risk polypharmacy was defined as the use of more than eight medications. The heart recipients were divided into two groups based on how many medications they received daily.

Results. The study included patients observed at the Consultative & Diagnostic Department, Shumakov Center from January 2008 to December 2017. The number of drugs taken by the patient at year 5 of follow-up was 9.2 ± 4.2. During the conducted data analysis, the mean total MRCI score was 48.72 ± 19.15 (from 32 to 70); medications used to treat comorbidities accounted for 42.9% of the total MRCI score, and immunosuppressive therapy accounted for 28.7%. The total MRCI score in the high-risk polypharmacy group was 58.49 ± 17.41; medications used to treat comorbidities accounted for 50.27% of the total MRCI score. The analysis revealed a correlation between the total MRCI score and the frequency of hospitalizations.

Conclusions. Patient adherence to prescribed treatment is a predictor of favorable prognosis of event-free long-term survival, but low adherence and therapeutic inertness are associated with decreased quality of life, more frequent hospitalizations and higher risk of adverse events. With proper outpatient follow-up of this patient cohort, there were no significant differences in survival in the polypharmacy and high-risk polypharmacy group.

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