A Survey of the Actual State of Medication Adherence and Physical Condition Management Among Outpatients with Heart Failure Before and After the Introduction of the Heart Failure Seal

The heart failure seal was introduced in the Aso region of Kumamoto Prefecture to improve the quality of heart failure management. In this study, we investigated the actual state of medication adherence and physical condition management before and after affixing the heart failure seal to the medication record book of outpatients with heart failure. Questionnaires were administered to 57 heart failure patients to whom the heart failure seal was applied for the first time at the initial, intermediate (at least 56 days after the initial application), and final (at least 112 days after the initial application) time points. The primary endpoint was the change in medication status over time, which was assessed using the Morisky Medication Adherence Scale 4 Items (MMAS-4) and self-rated medication status score. The secondary endpoints were changes over time in body condition score and subjective symptoms associated with heart failure, with body condition score assessed by self-assessment of fluid, salt, and weight control. The MMAS-4 values at the midpoint (P = 0.004) and final (P = 0.008) were lower than the initial scores. The medication status self-rating scores were greater at the midterm (P = 0.014); however, there was no difference at the final point compared with baseline. Both self-rating scores for physical condition were also greater at the midterm and final. Furthermore, the above associations were confirmed by structural equation modeling. The results suggest that the heart failure seal is effective for medication adherence and physical condition management in patients with heart failure.