Patient-reported outcomes and associated factors in patients with heart failure: a cross-sectional study in a Malaysian medication therapy adherence clinic.

BACKGROUND: Guideline-directed medical therapy (GDMT), including newer agents such as sodium-glucose cotransporter 2 inhibitors (SGLT2i), is integral to heart failure (HF) management. However, patient-centered outcomes, including adherence, treatment burden, and quality of life (QOL), remain underexplored in pharmacist-led settings. OBJECTIVES: This study aimed to examine medication adherence, treatment burden, QOL, and associated sociodemographic and clinical factors among HF patients receiving care at a Malaysian Medication Therapy Adherence Clinic (MTAC). DESIGN: A cross-sectional study was conducted among 78 HF patients attending an MTAC in a public hospital. METHODS: Patient-reported outcomes were assessed using the Malaysia Medication Adherence Assessment Tool (MyMAAT-12), the 15-item Treatment Burden Questionnaire (TBQ), and the WHOQOL-BREF. Total scores were analyzed as approximately continuous outcome measures. Exploratory linear regression models were used to assess associated factors, with age and gender included as covariates. Spearman correlation was used to assess relationships between the three outcomes. RESULTS: The mean age of participants was 57.3 ± 11.5 years, and 74.4% were male. Most patients were Malay (76.9%), and all were on polypharmacy (mean 6.6 medication classes). Median scores were 57.0 (IQR: 53.0-60.0) for adherence (MyMAAT-12 range 12-60), 22.0 (IQR: 16.3-32.8) for treatment burden (TBQ range 0-150), and 87.0 (IQR: 79.3-95.0) for QOL. Overall, 54 of 73 patients (74.0%) met the adherence threshold. Treatment burden was inversely correlated with QOL (r = -0.30, p = 0.009), while its correlation with adherence was weaker (r = -0.22, p = 0.061). In exploratory multivariable models, higher treatment burden was associated with lower adherence (beta = -0.17, p = 0.002) and lower QOL (beta = -0.17, p = 0.017). Higher household income was associated with higher QOL (beta = 2.75 per RM1000, p = 0.001). SGLT2i use was associated with higher QOL scores (beta = 9.95, p = 0.002), although this medication-class finding should be interpreted cautiously given the cross-sectional design. CONCLUSION: In this MTAC-managed HF population, treatment burden and socioeconomic factors were associated with patient-reported outcomes. The medication-class associations observed in this exploratory analysis should be interpreted as hypothesis-generating rather than causal. These findings support assessing treatment burden and social vulnerability in pharmacist-led HF care.