Non‐adherence to heart failure medications predicts clinical outcomes: assessment in a single spot urine sample by liquid chromatography‐tandem mass spectrometry (results of a prospective multicentre study)

Aims Liquid chromatography-mass spectrometry (LC-MS/MS) is an objective new technique to assess non-adherence medications. We used this method study the prevalence, predictors and outcomes of in patients with heart failure reduced left ventricular ejection fraction (HFrEF). Methods results This included 1296 HFrEF from BIOSTAT-CHF, a that aimed optimise guideline-recommended therapies. Angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), mineralocorticoid antagonists, β-blockers loop diuretics were measured single spot urine sample at 9 months using LC-MS/MS. The relationship between medication composite endpoint all-cause death or hospitalisation, over median follow-up 21 months, was evaluated. Non-adherence least one prescribed observed 45.9% patients. strongest predictor any other classes (P < 0.0005). Regional differences within Europe observed. On multivariable analyses, ACEi/ARBs associated increased risk [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.09–1.95, P = 0.008 HR 1.48, CI 1.12–1.96, 0.006, respectively). also (HR 2.48, 1.67–3.68, Patients who non-adherent healthier had decreased 0.69, 0.51–0.93, 0.014). antagonists not related clinical outcome. Conclusion medications, assessed by test, common predicts HFrEF.