Adherence to Non-Selective Beta Blockers for Prevention of Variceal Bleeding in Cirrhotic Patients

Abstract

Yang An,1– 3,* Xiangbo Xu,1– 3,* Tianshu Ren,1– 3,* Zhenhua Tong,1,4,* Fernando Gomes Romeiro,5 Andrea Mancuso,6 Xiaozhong Guo,1 Xingshun Qi1 1Liver Cirrhosis Study Group, Department of Gastroenterology, General Hospital of Northern Theater Command, Shenyang, 110840, People’s Republic of China; 2Postgraduate College, Shenyang Pharmaceutical University, Shenyang, 110016, People’s Republic of China; 3Department of Pharmacy, General Hospital of Northern Theater Command, Shenyang, 110840, People’s Republic of China; 4Section of Medical Service, General Hospital of Northern Theater Command, Shenyang, 110840, People’s Republic of China; 5Department of Internal Medicine, Botucatu Medical School, UNESP – Univ Estadual Paulista. Av. Prof. Mário Rubens Guimarães Montenegro, s/n Distrito de Rubião Jr, Botucatu, Brazil; 6Medicina Interna 1, ARNAS-Civico, Di Cristina-Benfratelli, Palermo, Italy*These authors contributed equally to this workCorrespondence: Xingshun Qi; Xiaozhong Guo Email [email protected]; [email protected] and Aim: Long-term use of non-selective beta blockers (NSBBs) is essential for the prevention of esophageal variceal bleeding in liver cirrhosis but may impair the patient’s adherence. The present study aimed to investigate the adherence to NSBBs to prevent variceal bleeding in cirrhotic patients.Methods: All patients who had an indication of NSBBs for the prophylaxis of variceal bleeding between February 2018 and June 2019 were screened. Clinical pharmacists gave pre-medication education and recorded the adherence to NSBBs during the patients’ hospitalizations. Factors associated with poor adherence were evaluated by univariate logistic regression analysis. Odds ratios (OR) with 95% confidence intervals (CI) were calculated. The relationship between poor adherence during follow-up and variceal bleeding after discharge was also evaluated.Results: Overall, 108 patients were screened, of whom 12 were intolerant to NSBBs. Among the 96 remaining patients who could take NSBBs, the average change of heart rate after NSBBs was − 10.49 b.p.m. Twenty-two (22.9%) patients had poor adherence to NSBBs due to their refusal to take NSBBs (n = 2), complete forgetfulness to take NSBBs (n = 10), and refusal or forgetfulness to monitor heart rate (n = 10). Univariate logistic regression analysis demonstrated that only older age was significantly associated with poor adherence (OR: 1.065, 95% CI: 1.019– 1.114, P = 0.005). Patients with poor adherence during follow-up were more likely to develop variceal bleeding after discharge.Conclusion: A significant proportion of cirrhotic patients had poor adherence to NSBBs during their hospitalizations. Further studies should explore how to improve the patient’s adherence to NSBBs.Keywords: liver cirrhosis, esophageal varices, non-selective beta blockers, adherence, risk factors

Keywords

• liver cirrhosis
• esophageal varices
• non-selective beta blockers
• adherence
• risk factors