Association between levels of high sensitivity c-reactive protein and poor medication adherence among heart failure patients attending care and treatment at Jakaya Kikwete cardiac institute in Dar es salaam, Tanzania

Abstract

ABSTRACT Background: Evidences show that non-adherence to medications in heart failure (HF) patients highly contribute to preventable re-hospitalization, morbidity and mortality. Recently, conjunction of neuro-hormonal and immune system role in heart muscles remodeling and deterioration of HF has been elucidated, in which C-reactive protein (CRP) also plays a role. Plasma changes of very low levels of CRP, measured using high sensitivity CRP (hsCRP) have been found to change with HF progression and hence predict HF prognosis among Western HF cohorts. However, studies on use of hsCRP as a measure of effectiveness and adherence to HF treatment are lacking in our local setting and literature does not show whether hsCRP levels can be used as a marker of medications adherence among HF patients. Aims: This study aimed at determining the association between HF medications adherence status and hsCRP levels among HF patients attending care and treatment at the Jakaya Kikwete Cardiac Institute (JKCI) in Dar es Salaam, Tanzania. Methodology: This was a cross-sectional descriptive-analytical study, conducted at JKCI. Consecutive sampling technique was employed to recruit eligible HF patients as they attended their regular clinic visits on Doctors’ schedule until the sample size was reached. Case report forms and the 8-item Morisky medications adherence scale tool were used to collect patients’ socio-demographic and clinical information, as well as to assess patients’ adherence to HF medications. For each patient, venous blood was collected and sent to the Muhimbili Central Pathology Laboratory where it was analyzed for hsCRP, complete blood count and cholesterol panel. Data were analyzed using Statistical Package for Social Sciences (SPSS) software version 21. Results: In total 210 HF patients who were eligible, and had complete data constitute the current study population. The mean ±SD age of patients was 54 ±15.9 years and 113 (53.8%) were females. One hundred and thirty-eight (65.7%) patients were found to have poor HF medications. In the total study population, the mean ±SD hsCRP was 7.15±4.94mg/L, and 122 (58.1%) patients were found to have elevated (>5mg/L) hsCRP levels. The mean ±SD hsCRP levels were significantly higher among patients with poor adherence (7.75 ±5.00mg/L) when compared to those with good adherence (5.72 ±4.59mg/L), p< 0.01. Furthermore, patients with poor medications adherence were more likely to have elevated hsCRP levels (68.1%) when compared to patients with good adherence (38.9%), p< 0.001. In multivariate logistic regression analysis, the independent associations of poor medications adherence were elevated hsCRP 4.27(2.14 – 8.51, p<0.001) and having ≥stage 2 hypertension on the day of clinic visit 2.72 (1.01 – 7.46, p = 0.05). Conclusion: This study has found that elevated hsCRP is strongly associated with poor HF medications adherence among HF patients attending care and treatment at JKCI, and the possibility to use measurements of hsCRP levels in the routine clinical follow-up investigations of patients with HF in order to know their adherence to medications. Further studies from different clinical settings are recommended to confirm the interesting findings obtained from this study. If confirmed, hsCRP level can, in the future be considered as a surrogate marker of HF medications adherence among HF patients in our local setting.