DOES ENCOURAGING GOOD COMPLIANCE IMPROVE PATIENTS CLINICAL CONDITION IN HEART-FAILURE

The aim of this study was to determine whether improved compliance by intensive medication counselling, given by a pharmacist, to elderly pa tients with chronic stable heart failure can influence both objective and subjective measures of heart failure. Elderly patients were random ly allocated to receive a 3-month counselling programme, or no counsel ling, Measures recorded at the beginning and end of the study included ; submaximal 6-minute exercise tests, visual analogue scores of breath lessness, the Nottingham Health Profile, and clinical signs of heart f ailure. Compliance was measured by a tablet count and medication knowl edge assessed by means of a questionnaire, There was no significant di fference between the groups in their initial level of compliance, medi cation knowledge or other assessments. Compliance improved for the cou nselled group by 32% (P<0.001) but remained unchanged for controls, Me dication knowledge improved for the counselled group only. The 6-minut e exercise test improved by 20 metres from a baseline of 137 m for the counselled group (P<0.005) but worsened by 22 m for the control group (P<0.01). Distance to breathlessness improved for the counselled pati ents and worsened for controls. In contrast bodyweight, jugular venous pressure and Nottingham Health Profile scores did not change signific antly for either group, Peripheral and pulmonary oedema scores improve d for the counselled group (P<0.01) but remained unchanged for control s. A small improvement was seen in the visual analogue scores (P<0.05) for the counselled group only, Improved compliance due to intensive m edication counselling had a small but measurable beneficial effect on objective measures of heart failure. However, the beneficial effect wa s small compared with the increase in compliance. It is doubtful wheth er improved compliance produces a clinically relevant benefit in elder ly patients with heart failure.