Medication Adherence and Health Literacy in Patients with Heart Failure: A Cross-Sectional Survey in Iran.

BACKGROUND: Heart failure is a costly condition with high morbidity and mortality rates in low- and middle-income countries. Nonadherence to prescribed therapies can lead to severe problems such as poorer health outcomes, higher health care expenditures, increased hospitalizations, and even higher mortality rates in patients with advanced heart disease. OBJECTIVE: The aim of the present study is to investigate medication adherence and the association between medication adherence and health literacy in Iranian patients with heart failure. METHODS: This study was conducted in the heart failure outpatient clinic of Shahid Rajaee Cardiovascular, Medical, and Research Center in Tehran, Iran. Medical records and validated questionnaires were used to collect the necessary information on the survey variables, including sociodemographic characteristics, medication adherence, and health literacy, for a total of 250 patients with heart failure. Stepwise logistic regression analysis was performed to identify the variables that independently and significantly predicted medication nonadherence. KEY RESULTS: The results showed that most patients with heart failure had low medication adherence. Some factors, including gender, health literacy, and duration of illness, were associated with adherence. The study results showed a positive association between higher health literacy and better medication adherence. CONCLUSION: In view of the results, further studies on heart failure are needed to investigate other factors related to medication adherence and health literacy level to achieve better disease management and improve patients' treatment adherence. [HLRP: Health Literacy Research and Practice. 2022;6(3):e191-e199.] Plain Language Summary: This study investigated the relationship between medication adherence and health literacy in Iranian patients with heart failure. The results showed that most patients had inadequate health literacy. Moreover, it showed a significant and positive relationship between health literacy and medication adherence.

CT-measured pulmonary artery diameter as an independent predictor of pulmonary hypertension in cystic fibrosis.

PURPOSE: The role of computed tomography (CT) scan, as a promising prognostic imaging modality in cystic fibrosis (CF), has been widely investigated, focusing on parenchymal abnormalities. The aim of the present study was to evaluate the diagnostic performance of thoracic vascular parameters on CT to detect pulmonary hypertension (PH). MATERIAL AND METHODS: CF patients who contemporaneously underwent CT and echocardiography were retrospectively enrolled. Baseline characteristics in addition to pulmonary artery diameter (PAD) and pulmonary to aortic (PA/A) ratio were compared between cohorts with and without PH, based on the results of echocardiography separately in paediatric patients (< 18) and adults (≥ 18). RESULTS: Of a total 119 CF patients, 39 (32.8%) had PH (paediatric: 23/78, 29.5%, adult: 16/41, 39%). In paediatric CF patients, mean age, HCo3, PCo2, and pulmonary artery diameter (PAD) were significantly higher in the PH group compared to the non-PH group. Mean pulmo however, only PAD remained as the independent predictor of PH based on multivariate analysis (overall: 22.86 mm [±3.86] vs. 18.43 mm [±4.72], p = 0.005, paediatric patients: 22.63 mm [±4.4] vs. 17.10 mm [±4.64], p = 0.03). Using a cut off of 19.25 mm, the diagnostic performance of PAD to detect PH was found to be as follows: sensitivity = 82%, specificity = 70%, and accuracy = 73.1%. No significant difference was demonstrated in PAD between PH and non-PH groups in adults with CF (23.19 [±3.60] vs. 21.34 [±3.49], p = 0.7). CONCLUSIONS: In CF patients, PAD revealed an age-dependent performance to detect PH. PAD can be applied to predict pulmonary hypertension in paediatric CF patients and may be recommended to be routinely measured on follow-up chest CT scan in childhood CF.

Significant effects of 4-aminopyridine and tetraethylammonium in the treatment of 6-hydroxydopamine-induced Parkinson's disease.

Parkinson's disease (PD) is a progressive neurodegenerative disorder characterizing by degeneration of dopaminergic neurons in the nigrostriatal pathway. The discovery of levodopa revolutionized the treatment of PD however, after several years of treatment most patients develop involuntary movements which significantly impair the quality of life. 4-Aminopyridine (4-AP) and tetraethylammonium (TEA) are wide-spectrum potassium channel blockers which based on the animal model studies and clinical trials have beneficial effects in treatment of several neurological disorders such as ataxia, Alzheimer disease and multiple sclerosis. Current study investigates effect of these blockers in the treatment of 6-hydroxydopamine (6-OHDA)-induced Parkinsonism. After surgical injection of 6-OHDA into medial forebrain bundle, behavioral tests were performed in the 2nd and 3rd weeks post-surgery. Only animals which showed more than 100 apomorphine-induced rotations/1h in the 3rd week were selected for evaluation of the blocker effects. Statistical analysis of results from rotational test shows that application of high dose of 4-AP (1mg/kg) and moderate dose of TEA (2mg/kg) attenuate behavioral symptoms of the Parkinsonism while high dose of TEA (5mg/kg) and application both 4-AP and TEA exacerbates these symptoms. Results from elevated body swing test confirmed the effects of TEA but not 4-AP on the rotational test. However, experiments performed on the partial Parkinsonian rats show that application of high dose of TEA attenuates apomorphine-induced rotational asymmetry significantly. Our findings indicating TEA and 4-AP could have significant effects in attenuation of PD symptoms but these effects are sensitive to dose and degree of severity of PD.