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The Medication Regimen of Patients With Heart Failure

The Gerontologic Considerations and Anticholinergic Burden

A Mixed-Methods Study

Knecht, Janet G. PhD, RN; Neafsey, Patricia J. PhD (Pharmacology)

doi: 10.1097/JCN.0000000000000302
ARTICLES: Heart Failure

Background: Although prescription medication adherence has been studied in the population living with heart failure (HF), little attention has focused on the patient’s overall medication practices including over-the-counter medications. Patients with HF live with the certainty that their quality of life depends on the proper management of multiple medications. Failure to properly manage prescription medications increases the risk of exacerbation of HF and increased rates of rehospitalization.

Objectives: The aim of the quantitative component of this study was to identify medication practices in patients with HF. The aim of the qualitative component was to identify themes of patients with high and low HF medication self-efficacy.

Methods: A convergent parallel mixed-methods design was followed. Quantitative interviews were conducted by telephone with 41 patients living with HF around their medication-taking and lifestyle behaviors. Immediately thereafter, qualitative interviews were conducted to elicit the patient’s perspective of their therapeutic regimen.

Results: Patients are prescribed medications not recommended for the gerontologic population and/or risk anticholinergic burden. Although highly confident, patients admit to a plethora of errors.

Conclusion: Future study is required to ensure safe transitions to home and enhance technology to provide seamless communication between patients and providers.

Janet G. Knecht, PhD, RN Assistant Professor of Nursing, University of Saint Joseph, West Hartford, Connecticut.

Patricia J. Neafsey, PhD (Pharmacology) Professor Emeritus, University of Connecticut, Storrs; and Cofounder and Chief Scientific Officer, ActualMeds Corp, East Hartford, Connecticut.

The University of Connecticut granted an exclusive license for the survey software used in this study to ActualMeds Corp in 2009. P.J.N. receives a percentage of the software license fee charged by the University of Connecticut. The University of Connecticut and she are shareholders of ActualMeds Corp. J.G.K. has no conflicts of interest to disclose.

Correspondence Janet G. Knecht, PhD, RN, University of Saint Joseph, 1678 Asylum Ave, West Hartford, CT 06117 (

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