Abstract
Background: Medication adherence is crucial to optimize outcomes in heart failure with reduced ejection fraction (HFrEF), yet determinants of adherence in Vietnamese patients remain under-described.
Objectives: To (1) assess medication adherence in hospitalized HFrEF patients and (2) identify factors associated with adherence at the Viet Nam National Heart Institute.
Methods: Cross-sectional study of adults (≥18 years) with HFrEF (EF ≤40%) admitted from July–October 2024. Sociodemographic and clinical data were collected via face-to-face interview and chart review. Adherence was measured using the 11-item General Medication Adherence Scale (GMAS; total score 0–33). Patients were classified as adherent (≥ 27) or non-adherent (≤ 26). Descriptive statistics, chi-square tests, and multivariable logistic regression were applied (p<0.05).
Results: Of 107 patients (mean age 66.61±12.08 years; 56.1% male), hypertension (50.5%) and diabetes (38.3%) were the most common comorbidities; mean EF was 36.14±3.08%; NYHA class II and III accounted for 42.1% and 57.9%, respectively. The mean GMAS total score was 28.21±3.63. By GMAS domains, mean scores were PBNA 12.50±2.21, ADPB 10.48±1.55, and CRNA 5.23±0.86. Using the study classification, 74.8% were adherent and 25.2% non-adherent.
In bivariable analysis, renal failure (p=0.021) and shorter disease duration (p=0.035) were associated with non-adherence. In multivariable models, female sex (aOR 5.35; 95%CI 1.27–22.48; p=0.02) and education ≥ secondary (aOR 12.66–14.80; p<0.01) independently predicted higher adherence; age, economic source, comorbidities, and NYHA class were not significant. Behavior-related non-adherence (PBNA) was the most frequent domain-specific barrier (18.7%), followed by cost-related (16.8%) and pill-burden/comorbidity (10.3%).
Conclusions: Nearly three-quarters of hospitalized HFrEF patients were adherent to medications. Higher education and female sex were independent correlates of better adherence, whereas behavioral barriers predominated among non-adherent patients. Patient-centered education and practical adherence supports (e.g., reminders, counseling) should be prioritized to improve outcomes.