Small Talk - Autumn 2017

Compliance with prescribed therapy is particularly important in the management of heart failure since it is not a curable condition; it is a long term chronic problem which needs daily therapy to manage the clinical signs. In human medicine, treatment that is ongoing tends to be associated with poorer compliance than short term treatment, and if compliance with heart failure therapy is poor it has been shown in humans to inevitably lead to worsening of the heart failure itself, possibly leading to hospitalisation. In addition, it has been shown that medicating human patients and dogs that are in heart failure with a variety of treatments including Pimobendan and benazepril prolongs life. Compliance is essentially ‘the extent to which owners adhere to instructions when giving prescribed drugs to their animals’. In human medicine, it has been documented that compliance levels range from 5%-96%. The small number of compliance studies that are available in the veterinary literature differ quite substantially in the levels of compliance demonstrated. One study suggests that only 37% of clients are 100% compliant with prescribed treatment and of these the best compliance was seen in the group of animals being treated for gastrointestinal problems. In veterinary medicine, a study conducted by the American Animal Hospital Association revealed that client compliance is much lower than veterinarians had predicted. The study looked at estimated levels of compliance in small animal practice and concluded that the majority of veterinary practitioners surveyed believed their client adherence levels were as high as 75% when in reality the average rate was found to be 50%. This means that only half of the clients seen in those practices followed through on the treatments their veterinarians recommended. In studies of compliance with antimicrobial medication, the correct number of doses was given by only 27% of clients and only 7% clients had correctly followed the treatment regime. The large range in compliance levels shown in these studies offers scope for improvement, but failure to comply with treatment recommendations for a chronic condition like cardiac failure, in which the control of clinical signs requires continuous daily administration of medication, can lead to an inadequate treatment response and in cardiac failure patients, this means the return of life-threatening clinical signs and even death.