ArticleThe Pan African medical journal2026
Predictors and impact of medication non-adherence in heart failure patients: a retrospective cohort from a tertiary hospital in Yemen.
Article in The Pan African medical journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: medication adherence is crucial for managing heart failure (HF), yet non-adherence remains a significant challenge, particularly in resource-limited settings. Data on its determinants and impact in Yemen are scarce. This study aimed to identify predictors of clinician-documented non-adherence and evaluate its impact on readmission and mortality in a Yemeni HF cohort. Methods: we conducted a retrospective cohort study of 162 HF patients at Al-Thawra General Hospital, Ibb, Yemen, from January 2021 to January 2025. The exposure was clinician-documented medication non-adherence. Primary outcomes were hospital readmission and all-cause mortality within 180 days. Independent predictors were identified using multivariate logistic regression. Outcomes were compared using chi-square tests, with relative risks (RR) and number needed to harm (NNH) calculated. Results: medication non-adherence was documented in 64 patients (39.5%). Independent predictors included older age (adjusted Odds Ratio [aOR] 1.15 per year; 95% CI: 1.09-1.22; p<0.001), male gender (aOR 4.1; 95% CI: 1.1-15.2; p=0.017), smoking (aOR 12.4; 95% CI: 3.3-47.4; p=0.015), khat chewing (aOR 2.95; 95% CI: 1.21-7.19; p=0.018), and chronic kidney disease (aOR 4.12; 95% CI: 1.02-16.67; p=0.047). Non-adherent patients had significantly higher readmission (79.7% vs. 13.3%; RR 6.0; 95% CI: 3.5-10.2) and mortality rates (25.0% vs. 6.1%; RR 4.1; 95% CI: 1.7-9.8). The NNH was 2.1 for readmission and 5.3 for mortality. Conclusion: in this single-centre Yemeni cohort, clinician-documented non-adherence was prevalent and strongly predicted by specific demographic, behavioral, and clinical factors. The independent predictors of non-adherence in this setting include advanced age, male gender, smoking, khat chewing, and chronic kidney disease. Non-adherence was associated with a dramatically increased risk of readmission and death. These findings highlight the urgent need for targeted interventions addressing modifiable risks like smoking and khat use to improve outcomes in this and similar settings.
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