1
|
Carrillo A, Belnap BH, Rothenberger SD, Feldman R, Rollman BL, Celano CM. Psychosocial predictors of health behavior adherence in heart-failure patients with comorbid depression: a secondary analysis of the Hopeful Heart trial. BMC Psychol 2024; 12:328. [PMID: 38835104 PMCID: PMC11151478 DOI: 10.1186/s40359-024-01816-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Depression affects 20-30% of individuals with heart failure (HF), and it is associated with worse health outcomes independent of disease severity. One potential explanation is the adverse impact of depression on HF patients' adherence to the health behaviors needed to self-manage their condition. The aim of this study is to identify characteristics associated with lower adherence in this population, which could help to recognize individuals at higher risk and eventually tailor health behavior interventions to their needs. METHODS Using data from a randomized, controlled, collaborative care treatment trial in 629 patients with HF and comorbid depression, we performed mixed effects logistic regression analyses to examine the cross-sectional and prospective relationships between medical and psychosocial variables and health behavior adherence, including adherence to medications, a low-sodium diet, and physician appointments. RESULTS In cross-sectional analyses, married marital status and higher physical health-related quality of life (HRQoL) were associated with greater overall adherence (compared to married, single Odds Ratio [OR] = 0.46, 95% Confidence Interval [CI] = 0.26-0.80; other OR = 0.60, CI = 0.38-0.94; p = .012. Physical HRQoL OR = 1.02, CI = 1.00-1.04, p = .047). Prospectively, greater levels of social support were associated with improved overall adherence one year later (OR = 1.04, 95% CI = 1.00-1.08, p = .037). Social support, HF symptom severity, race and ethnicity, and age were predictors of specific types of adherence. Neither depression nor optimism was significantly associated with adherence outcomes. CONCLUSIONS These results provide important preliminary information about risk factors for poor adherence in patients with both HF and depression, which could, in turn, contribute to the development of interventions to promote adherence in this high-risk population. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT02044211 ; registered 1/21/2014.
Collapse
Affiliation(s)
- Alba Carrillo
- Instituto Polibienestar, University of Valencia, Valencia, Spain
- Department of Psychiatry, Massachusetts General Hospital, 125 Nashua Street, Suite 324, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, USA
| | - Bea Herbeck Belnap
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Scott D Rothenberger
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert Feldman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Division of General Internal Medicine, Center for Research on Health Care Data Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Bruce L Rollman
- Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Center for Behavioral Health, Media, and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Christopher M Celano
- Department of Psychiatry, Massachusetts General Hospital, 125 Nashua Street, Suite 324, Boston, MA, 02114, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
2
|
Salam AM, Sulaiman K, Alsheikh-Ali AA, Singh R, AlHabib KF, Al-Zakwani I, Asaad N, Al-Qahtani A, Al-Jarallah M, AlMahmeed W, Bulbanat B, Ridha M, Bazargani N, Amin H, Al-Motarreb A, Panduranga P, AlFaleh H, Shehab A, Al Suwaidi J. Precipitating Factors for Hospitalization with Heart Failure: Prevalence and Clinical Impact Observations from the Gulf CARE (Gulf aCute heArt failuRe rEgistry). Med Princ Pract 2020; 29:270-278. [PMID: 31522185 PMCID: PMC7315136 DOI: 10.1159/000503334] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 09/15/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Despite the expanding burden of heart failure (HF) worldwide, data on HF precipitating factors (PFs) in developing countries, particularly the Middle East, are very limited. We examined PFs in patients hospitalized with acute HF in a prospective multicenter HF registry from 7 countries in the Middle East. METHOD Data were derived from the Gulf CARE (Gulf aCute heArt failuRe rEgistry) for a prospective, multinational, multicenter study of consecutive patients hospitalized with HF in 47 hospitals in 7 Middle Eastern countries between February 2012 and November 2012. PFs were determined by the treating physician from a predefined list at the time of hospitalization. RESULTS The study included 5,005 patients hospitalized with acute HF, 2,276 of whom (45.5%) were hospitalized with acute new-onset HF (NOHF) and 2,729 of whom (54.5%) had acute decompensated chronic HF (DCHF). PFs were identified in 4,319 patients (86.3%). The most common PF in the NOHF group was acute coronary syndromes (ACS) (39.2%). In the DCHF group, it was noncompliance with medications (27.8%). Overall, noncompliance with medications was associated with a lower inhospital mortality (OR 0.47; 95% CI 0.28-0.80; p = 0.005) but a higher 1-year mortality (OR 1.43; 95% CI 1.1-1.85; p = 0.007). ACS was associated with higher inhospital mortality (OR 1.84; 95% CI 1.26-2.68; p = 0.002) and higher 1-year mortality (OR 1.62; 95% CI 1.27-2.06; p = 0.001). CONCLUSION Preventive and therapeutic interventions specifically directed at noncompliance with medications and ACS are warranted in our region.
Collapse
Affiliation(s)
- Amar M Salam
- College of Medicine, Qatar University, Doha, Qatar,
- Adult Cardiology, Hamad Medical Corporation, Doha, Qatar,
| | | | - Alawi A Alsheikh-Ali
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates
- Institute of Cardiac Sciences, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Rajvir Singh
- Biostatistics Section, Cardiovascular Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khalid F AlHabib
- Department of Cardiac Sciences, King Fahad Cardiac Center, King Saud University, Riyadh, Saudi Arabia
| | - Ibrahim Al-Zakwani
- Department of Pharmacology and Clinical Pharmacy, College of Medicine and Health Sciences, Sultan Qaboos University, and Gulf Health Research, Seeb, Oman
| | - Nidal Asaad
- College of Medicine, Qatar University, Doha, Qatar
| | | | | | | | - Bassam Bulbanat
- Department of Cardiology, Sabah Al-Ahmed Cardiac Center, Kuwait, Kuwait
| | - Mustafa Ridha
- Department of Cardiology, Adan Hospital, Kuwait, Kuwait
| | - Nooshin Bazargani
- Department of Cardiology, Dubai Hospital, Dubai, United Arab Emirates
| | - Haitham Amin
- Department of Cardiology, Mohammed Bin Khalifa Cardiac Center, Manamah, Bahrain
| | - Ahmed Al-Motarreb
- Department of Cardiology, Faculty of Medicine, Sana'a University, Sana'a, Yemen
| | | | - Husam AlFaleh
- Department of Cardiology and Cardiovascular Surgery, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, UAE University, Al Ain, United Arab Emirates
| | | |
Collapse
|
3
|
Martin LR, Feig C, Maksoudian CR, Wysong K, Faasse K. A perspective on nonadherence to drug therapy: psychological barriers and strategies to overcome nonadherence. Patient Prefer Adherence 2018; 12:1527-1535. [PMID: 30197504 PMCID: PMC6112807 DOI: 10.2147/ppa.s155971] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Medication adherence represents an inefficiency and ongoing challenge within medical care. The problem has been long-recognized - indeed, the research literature contains thousands of articles on the topic. Nonetheless, because of the complex nature of the problem, it still cannot be considered to be solved. Reasons for nonadherence are myriad but psychological barriers to adherence are most difficult to mitigate and, thus, are the focus of this paper. The present narrative review sketches a summary of theoretical models commonly utilized to understand and help address medication nonadherence; uses a patient-centered care approach to contextualize the problem of nonadherence to drug therapies; and then outlines a set of best-practice recommendations based on the extant data and framed from the perspective of the Information-Motivation-Strategy model.
Collapse
Affiliation(s)
- Leslie R Martin
- Department of Psychology and Neuroscience, La Sierra University, Riverside, CA, USA,
| | - Cheyenne Feig
- Department of Psychology and Neuroscience, La Sierra University, Riverside, CA, USA,
| | - Chloe R Maksoudian
- Department of Psychology and Neuroscience, La Sierra University, Riverside, CA, USA,
| | - Kenrick Wysong
- Department of Psychology and Neuroscience, La Sierra University, Riverside, CA, USA,
| | - Kate Faasse
- School of Psychology, University of New South Wales, Sydney, NSW, Australia
| |
Collapse
|
4
|
Medication Adherence Mediates the Relationship Between Heart Failure Symptoms and Cardiac Event-Free Survival in Patients With Heart Failure. J Cardiovasc Nurs 2018; 33:40-46. [PMID: 28591004 DOI: 10.1097/jcn.0000000000000427] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Heart failure (HF) symptoms such as dyspnea are common and may precipitate hospitalization. Medication nonadherence is presumed to be associated with symptom exacerbations, yet how HF symptoms, medication adherence, and hospitalization/death are related remains unclear. OBJECTIVE The aim of this study was to explore the relationships among HF symptoms, medication adherence, and cardiac event-free survival in patients with HF. METHODS At baseline, patient demographics, clinical data, and HF symptoms were collected in 219 patients with HF. Medication adherence was monitored using the Medication Event Monitoring System. Patients were followed for up to 3.5 years to collect hospitalization and survival data. Logistic regression and survival analyses were used for the analyses. RESULTS Patients reporting dyspnea or ankle swelling were more likely to have poor medication adherence (P = .05). Poor medication adherence was associated with worse cardiac event-free survival (P = .006). In Cox regression, patients with HF symptoms had 2 times greater risk for a cardiac event than patients without HF symptoms (P = .042). Heart failure symptoms were not a significant predictor of cardiac event-free survival after entering medication adherence in the model (P = .091), indicating mediation. CONCLUSIONS Medication adherence was associated with fewer HF symptoms and lower rates of hospitalization and death. It is important to develop interventions to improve medication adherence that may reduce HF symptoms and high hospitalization and mortality in patients with HF.
Collapse
|
5
|
Wierenga KL. Emotion Regulation and Perceptions of Illness Coherence and Controllability on Regimen Adherence and Negative Cardiac Health Events in African American Women With Heart Failure. J Cardiovasc Nurs 2018; 32:594-602. [PMID: 28398917 PMCID: PMC5633482 DOI: 10.1097/jcn.0000000000000403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND African American women with heart failure (HF) have stressors that negatively impact HF self-management adherence and heighten the occurrence of negative cardiac health events. Perceptions of illness coherence and controllability and emotion regulation are known to facilitate self-management in the face of stressors. OBJECTIVE The aim of this study was to determine whether difficulties with emotion regulation and negative perceptions of illness coherence and controllability are detrimental to adherence and increase negative cardiac health events in this patient population. METHODS African American women (n = 54) with HF, aged 49 to 84 years, participated in this longitudinal descriptive correlational study. Using convenience sampling, we recruited patients from hospitals and HF clinics. They completed interviews at intake and 30 days, and their medical records were reviewed at 90 days. Linear and logistic regression models were used to assess predictors of general adherence and negative cardiac health events. RESULTS Of 54 patients who participated in the study, 28 experienced a negative health event during 90 days, and 57% of these events were cardiac related. The only clear predictor of these events was greater New York Heart Association functional classification (β = 1.47, P = .027). No associations were found between predictors (emotion regulation, controllability, coherence, age, education) and general adherence. CONCLUSIONS Emotion regulation showed a possible greater impact on negative cardiac health events than on general adherence. Perceived illness coherence showed less impact on negative cardiac health events than on general adherence.
Collapse
Affiliation(s)
- Kelly L Wierenga
- Kelly L. Wierenga, PhD, RN Postdoctoral Fellow, Case Western Reserve University, Cleveland, Ohio
| |
Collapse
|
6
|
Osborn CY, Kripalani S, Goggins KM, Wallston KA. Financial strain is associated with medication nonadherence and worse self-rated health among cardiovascular patients. J Health Care Poor Underserved 2018; 28:499-513. [PMID: 28239015 DOI: 10.1353/hpu.2017.0036] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Non-traditional indicators of socioeconomic status (SES; e.g., home ownership) may be just as or even more predictive of health outcomes as traditional indicators of SES (e.g., income). This study tested whether financial strain (i.e., difficulty paying monthly bills) predicted medication non-adherence and worse self-rated health. Research assistants administered surveys to 1,527 patients with acute coronary syndromes or acute decom-pensated heart failure. In adjusted models, having a higher income was associated with being more adherent (p < .001), but was non-significant when adjusted for financial strain. Education, income, less financial strain, and being employed were each associated with better self-rated health (p < .001). Financial strain was associated with less adherence (β =-.17, p < .001) and worse self-rated health (β = -.23, p < .001), and mediated the effect of income on adherence (coeff = .078 [BCa 95% CI: .051 to .108]). Future research should further explore the nuanced link between SES and health behaviors and outcomes.
Collapse
|
7
|
Wu JR, Song EK, Moser DK, Lennie TA. Racial differences in dietary antioxidant intake and cardiac event-free survival in patients with heart failure. Eur J Cardiovasc Nurs 2018; 17:305-313. [DOI: 10.1177/1474515118755720] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background: Heart failure is a chronic, burdensome condition with higher re-hospitalization rates in African Americans than Whites. Higher dietary antioxidant intake is associated with lower oxidative stress and improved endothelial function. Lower dietary antioxidant intake in African Americans may play a role in the re-hospitalization disparity between African American and White patients with heart failure. Objective: The objective of this study was to examine the associations among race, dietary antioxidant intake, and cardiac event-free survival in patients with heart failure. Methods: In a secondary analysis of 247 patients with heart failure who completed a four-day food diary, intake of alpha-carotene, beta-carotene, beta-cryptoxanthin, lutein, zeaxanthin, lycopene, vitamins C and E, zinc, and selenium were assessed. Antioxidant deficiency was defined as intake below the estimated average requirement for antioxidants with an established estimated average requirement, or lower than the sample median for antioxidants without an established estimated average requirement. Patients were followed for a median of one year to determine time to first cardiac event (hospitalization or death). Survival analysis was used for data analysis. Results: African American patients had more dietary antioxidant deficiencies and a shorter cardiac event-free survival compared with Whites ( p = .007 and p = .028, respectively). In Cox regression, race and antioxidant deficiency were associated with cardiac event-free survival before and after adjusting for covariates. Conclusion: African Americans with heart failure had more dietary antioxidant deficiencies and shorter cardiac event-free survival than Whites. This suggests that encouraging African American patients with heart failure to consume an antioxidant-rich diet may be beneficial in lengthening cardiac event-free survival.
Collapse
Affiliation(s)
- Jia-Rong Wu
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, NC, USA
| | - Eun Kyeung Song
- Department of Nursing, College of Medicine, University of Ulsan, Korea
| | - Debra K Moser
- University of Kentucky, College of Nursing, Lexington, KY, USA
| | - Terry A Lennie
- University of Kentucky, College of Nursing, Lexington, KY, USA
| |
Collapse
|
8
|
Feasibility of including patients with migration background in a structured heart failure management programme: A prospective case-control study exemplarily on Turkish migrants. PLoS One 2017; 12:e0187358. [PMID: 29117200 PMCID: PMC5695597 DOI: 10.1371/journal.pone.0187358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 10/18/2017] [Indexed: 11/19/2022] Open
Abstract
AIMS Structured management programmes deliver optimized care in heart failure patients and improve outcome. We examined the feasibility of including patients with migration background speaking little or no German in a heart failure management programme. METHODS AND RESULTS After adaption of script material and staff to Turkish language we aimed to recruit 300 Turkish and 300 German (control group) patients within 18 months using the operational basis of a local heart failure management programme for screening, contact and inclusion. Of 488 and 1,055 eligible Turkish and German patients identified through screening, 165 Turkish (34%) and 335 German (32%) patients consented on participation (p = 0.46). General practitioners contributed significantly more of the Turkish (84%) than of the German patients (16%, p<0.001). Contact attempts by programme staff were significantly less successful in Turkish (52%) than in German patients (60%, p = 0.005) due to significantly higher rate of missing phone numbers (36% vs 25%), invalid address data (28% vs 7%) and being unreachable by phone more frequently (39% vs 26%, all p<0.001). Consent rate was significantly higher in successfully contacted Turkish (63%) compared to German patients (50%, p<0.001). CONCLUSION The inclusion of Turkish minority patients into a heart failure management programme is feasible with higher consent rate than in Germans. However, effort is high due to inherent logistic adaptions and barriers in identification and contacting of patients. TRIAL REGISTRATION DRKS00007780.
Collapse
|
9
|
Woda A, Haglund K, Belknap RA, Sebern M. Self-Care Behaviors of African Americans Living with Heart Failure. J Community Health Nurs 2017; 32:173-86. [PMID: 26529103 DOI: 10.1080/07370016.2015.1087237] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
African Americans have a higher risk of developing heart failure (HF) than persons from other ethnic groups. Once diagnosed, they have lower rates of HF self-care and poorer health outcomes. Promoting engagement in HF self-care is amenable to change and represents an important way to improve the health of African Americans with HF. This study used a community-based participatory action research methodology called photovoice to explore the practice of HF self-care among low-income, urban, community dwelling African Americans. Using the photovoice methodology, themes emerged regarding self-care management and self-care maintenance.
Collapse
Affiliation(s)
- Aimee Woda
- a College of Nursing , Marquette University , Milwaukee , Wisconsin
| | - Kristin Haglund
- a College of Nursing , Marquette University , Milwaukee , Wisconsin
| | - Ruth Ann Belknap
- a College of Nursing , Marquette University , Milwaukee , Wisconsin
| | - Margaret Sebern
- a College of Nursing , Marquette University , Milwaukee , Wisconsin
| |
Collapse
|
10
|
Chen HF, Homan S, Carlson E, Popoola T, Radhakrishnan K. The Impact of Race and Neighborhood Racial Composition on Preventable Readmissions for Diabetic Medicare Home Health Beneficiaries. J Racial Ethn Health Disparities 2016; 4:648-658. [PMID: 27514389 DOI: 10.1007/s40615-016-0268-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/04/2016] [Accepted: 07/06/2016] [Indexed: 12/25/2022]
Abstract
BACKGROUND The recommended home health financial penalty program for preventable readmission does not factor race/ethnicity and neighborhood racial compositions into the determination of preventable readmission rates. Home health agencies may avoid beneficiaries from certain racial/ethnic groups and neighborhoods if these two factors have an effect on preventable readmissions. We examined the association between preventable readmissions with race/ethnicity and neighborhood racial composition. METHODS Several 2009 national data were used, such as the Master Beneficiary Summary File, Medicare Provider Analysis and Review File, and Outcome Assessment Information Set. Our sample consisted of diabetic Medicare home health beneficiaries (African-Americans and Whites only). We analyzed predictors of time-to-first 30-day preventable readmission, including short/long-term diabetic complications, chronic obstructive pulmonary disease/asthma, bacterial pneumonia, dehydration, urinary tract infection, hypertension, heart failure, angina without procedure, uncontrolled diabetes, and lower-extremity amputation. RESULTS There were 86,567, 17,262, and 11,392 observations in neighborhoods with low (6 % African-Americans), moderate (35 % African-Americans), and high (76 % African-Americans) density of African-Americans, respectively. Using Cox regression models, we found that in neighborhoods with moderate and high density of African-Americans, African-Americans had 21 % (hazard ratio (HR) 1.21; 95 % confidence interval (CI) 1.04-1.39) and 24 % (HR 1.24; 95 % CI 1.01-1.52) significantly higher hazards of 30-day preventable readmissions than Whites, respectively. CONCLUSION Race and neighborhood racial compositions are beyond home health providers' control. These two factors should be considered as covariates for the preventable readmissions in the recommended home health financial penalty program.
Collapse
Affiliation(s)
- Hsueh-Fen Chen
- University of North Texas Health Science Center, Fort Worth, TX, USA. .,Department of Health Policy and Management College of Public Health, University of Arkansas Medical Sciences, 4301 West Markam, Slot 820-12, Little Rock, AR, USA.
| | - Sharon Homan
- Sinai Urban Health Institute, 1500 South Fairfield Avenue, Kurtzon 437, Chicago, IL, 60608, USA
| | - Erin Carlson
- Department of Health Management and Policy School of Public Health, University of North Texas Health Science Center, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Taiye Popoola
- Department of Health Policy and Management, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA
| | - Kavita Radhakrishnan
- Shool of Nursing, University of Texas- Austin, 1710 Red River Street, Austin, TX, 78701, USA
| |
Collapse
|
11
|
Wierenga KL, Dekker RL, Lennie TA, Chung ML, Dracup K. African American Race Is Associated With Poorer Outcomes in Heart Failure Patients. West J Nurs Res 2016; 39:524-538. [DOI: 10.1177/0193945916661277] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Health care disparities associated with African American race may influence event-free survival in patients with heart failure (HF). A secondary data analysis included 863 outpatients enrolled in a multicenter HF registry. Cox regression was used to determine whether African American race was associated with shorter HF event-free survival after controlling for covariates. The multivariable-adjusted hazard ratios (95% confidence intervals [CI]) of older age (1.03, 95% CI = [1.01, 1.04]), New York Heart Association (NYHA) functional class (1.73, 95% CI = [1.29, 2.31]), depressive symptoms (1.05, 95% CI = [1.02, 1.07]), and African American race (1.64, 95% CI = [1.01, 2.68]) were predictors of shorter event-free survival (all ps < .05). Comparisons showed that NYHA functional class was predictive of shorter event-free survival in Caucasians (1.81, 95% CI = [1.33, 2.46]) but not in African Americans (1.24, 95% CI = [.40, 3.81]). African Americans with HF experienced a disparate risk of shorter event-free survival not explained by a variety of risk factors.
Collapse
|
12
|
Wu JR, Lennie TA, Moser DK. A prospective, observational study to explore health disparities in patients with heart failure—ethnicity and financial status. Eur J Cardiovasc Nurs 2016; 16:70-78. [DOI: 10.1177/1474515116641296] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Jia-Rong Wu
- University of North Carolina at Chapel Hill School of Nursing, Chapel Hill, NC, USA
| | - Terry A Lennie
- University of Kentucky College of Nursing, Lexington, KY, USA
| | - Debra K Moser
- University of Kentucky College of Nursing, Lexington, KY, USA
- University of Ulster, Jordanstown, UK
| |
Collapse
|
13
|
Wu JR, Moser DK, DeWalt DA, Rayens MK, Dracup K. Health Literacy Mediates the Relationship Between Age and Health Outcomes in Patients With Heart Failure. Circ Heart Fail 2016; 9:e002250. [PMID: 26721913 DOI: 10.1161/circheartfailure.115.002250] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Previous studies have linked frequent rehospitalizations for heart failure (HF) and increased mortality with older age, higher severity of HF, lack of an evidence-based medication regimen, and inadequate health literacy. However, the pathway between age and health outcomes in patients with HF remains unknown. Therefore, the purpose of this study was to test whether the association between age and health outcomes can be explained by severity of HF, evidence-based medication use, and health literacy in patients with HF. METHODS AND RESULTS This was a longitudinal study of 575 rural patients with HF recruited from outpatient clinics and hospitals. Demographics, clinical data, and health literacy were collected at baseline. HF readmissions and cardiac mortality were followed for 2 years; 57% of patients were ≥ 65 years of age. Older patients with HF were more likely to have low health literacy and less likely to be prescribed angiotensin-converting enzyme inhibitors or β-blockers. Using Kaplan-Meier survival curves with log-rank tests, health outcomes were significantly worse in patients who were ≥ 65 years and in those with low health literacy. Separate Cox regressions revealed that age and health literacy predicted worse health outcomes (P = 0.006 and < 0.001, respectively). When health literacy was entered into the model, the hazard ratio for age changed from 1.49 to 1.29 (a 41% reduction); age was no longer a significant predictor of health outcomes, but health literacy remained significant (P < 0.001), demonstrating mediation. CONCLUSIONS Health literacy mediates the relationship between age and health outcomes in adults with HF. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT00415545.
Collapse
Affiliation(s)
- Jia-Rong Wu
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.).
| | - Debra K Moser
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Darren A DeWalt
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Mary Kay Rayens
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| | - Kathleen Dracup
- From the School of Nursing (J.-R.W.) and School of Medicine (D.A.D.W.), University of North Carolina at Chapel Hill; University of Kentucky, College of Nursing, Lexington (D.K.M., M.K.R.); University of Ulster, Jordanstown, Northern Ireland (D.K.M.); and School of Nursing, University of California San Francisco (K.D.)
| |
Collapse
|
14
|
Piamjariyakul U, Werkowitch M, Wick J, Russell C, Vacek JL, Smith CE. Caregiver coaching program effect: Reducing heart failure patient rehospitalizations and improving caregiver outcomes among African Americans. Heart Lung 2015; 44:466-73. [DOI: 10.1016/j.hrtlng.2015.07.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 07/28/2015] [Accepted: 07/31/2015] [Indexed: 11/28/2022]
|
15
|
Havranek EP, Mujahid MS, Barr DA, Blair IV, Cohen MS, Cruz-Flores S, Davey-Smith G, Dennison-Himmelfarb CR, Lauer MS, Lockwood DW, Rosal M, Yancy CW. Social Determinants of Risk and Outcomes for Cardiovascular Disease. Circulation 2015; 132:873-98. [DOI: 10.1161/cir.0000000000000228] [Citation(s) in RCA: 738] [Impact Index Per Article: 82.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
16
|
Kripalani S, Goggins K, Nwosu S, Schildcrout J, Mixon AS, McNaughton C, McDougald Scott AM, Wallston KA. Medication Nonadherence Before Hospitalization for Acute Cardiac Events. JOURNAL OF HEALTH COMMUNICATION 2015; 20 Suppl 2:34-42. [PMID: 26513029 PMCID: PMC4705844 DOI: 10.1080/10810730.2015.1080331] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Medication nonadherence increases the risk of hospitalization and poor outcomes, particularly among patients with cardiovascular disease. The purpose of this study was to examine characteristics associated with medication nonadherence among adults hospitalized for cardiovascular disease. Patients in the Vanderbilt Inpatient Cohort Study who were admitted for acute coronary syndrome or heart failure completed validated assessments of self-reported medication adherence (the Adherence to Refills and Medications Scale), demographic characteristics, health literacy, numeracy, social support, depressive symptoms, and health competence. We modeled the independent predictors of nonadherence before hospitalization, standardizing estimated effects by each predictor's interquartile range. Among 1,967 patients studied, 70.7% indicated at least some degree of medication nonadherence leading up to their hospitalization. Adherence was significantly lower among patients with lower health literacy (0.18-point change in adherence score per interquartile range change in health literacy), lower numeracy (0.28), lower health competence (0.30), and more depressive symptoms (0.52) and those of younger age, of non-White race, of male gender, or with less social support. Medication nonadherence in the period before hospitalization is more prevalent among patients with lower health literacy, numeracy, or other intervenable psychosocial factors. Addressing these factors in a coordinated care model may reduce hospitalization rates.
Collapse
Affiliation(s)
- Sunil Kripalani
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kathryn Goggins
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Sam Nwosu
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Jonathan Schildcrout
- d Department of Biostatistics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda S Mixon
- a Section of Hospital Medicine, Division of General Internal Medicine and Public Health, Department of Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- b Center for Clinical Quality and Implementation Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- e Department of Veterans Affairs , Tennessee Valley Healthcare System Geriatric Research Education and Clinical Center , Nashville , Tennessee , USA
| | - Candace McNaughton
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Amanda M McDougald Scott
- c Center for Health Services Research , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- f Department of Emergency Medicine , Vanderbilt University Medical Center , Nashville , Tennessee , USA
- g Department of Biomedical Informatics , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| | - Kenneth A Wallston
- h School of Nursing , Vanderbilt University Medical Center , Nashville , Tennessee , USA
| |
Collapse
|
17
|
Rodrigues SDLL, Rodrigues RCM, São-João TM, Pavan RBB, Padilha KM, Gallani MC. [Impact of the disease: acceptability, ceiling and floor effects and reliability of an instrument on heart failure]. Rev Esc Enferm USP 2014; 47:1091-8. [PMID: 24346448 DOI: 10.1590/s0080-623420130000500012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Accepted: 06/05/2013] [Indexed: 12/28/2022] Open
Abstract
This study evaluated the acceptability, ceiling/floor effects, and the reliability of the instrument for measuring the Impact of the Disease on the Daily Life of Patients with Valvular Disease (IDCV) when applied to 135 patients with heart failure (HF). Acceptability was evaluated by the percentage of unanswered items and by the proportion of patients who responded to all items; the ceiling/floor effects by the percentage of patients who scored in the top of 10% best and worst results of the scale, respectively. Reliability was estimated by internal consistency (Cronbach's alpha coefficient) and stability of the measure (intraclass correlation coefficient - ICC). All patients responded to all items. Ceiling/floor effects evidenced were of moderate magnitude. The Cronbach's alpha was satisfactory for the majority of the domains and ICC> 0.90 in all the domains. The IDCV proved to be an easy to understand questionnaire, with evidence of reliability in patients with HF.
Collapse
|
18
|
Wu JR, Lennie TA, Dekker RL, Biddle MJ, Moser DK. Medication adherence, depressive symptoms, and cardiac event-free survival in patients with heart failure. J Card Fail 2013; 19:317-24. [PMID: 23663814 DOI: 10.1016/j.cardfail.2013.03.010] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 03/07/2013] [Accepted: 03/23/2013] [Indexed: 12/27/2022]
Abstract
BACKGROUND Medication nonadherence and depressive symptoms predict hospitalization and death in patients with heart failure (HF). Depressed patients have lower medication adherence than nondepressed patients. However, the predictive power of the combination of medication adherence and depressive symptoms for hospitalization and death has not been investigated in patients with HF. OBJECTIVE The aim of this study was to explore the combined influence of medication adherence and depressive symptoms for prediction of cardiac event-free survival in patients with HF. METHODS AND RESULTS We monitored medication adherence in 216 HF patients who completed the Patient Health Questionnaire-9 (PHQ-9) at baseline. Medication adherence was measured objectively with the use of the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data on cardiac events. Survival analyses were used to compare cardiac event-free survival among groups. The risk of experiencing a cardiac event for patients with medication nonadherence and depressive symptoms was 5 times higher than those who were medication adherent without depressive symptoms. The risk of experiencing a cardiac event for patients with only 1 risk factor was 1.2-1.3 times that of those with neither risk factor. CONCLUSIONS Medication nonadherence and depressive symptoms had a negative synergistic effect on cardiac event-free survival in patients with HF.
Collapse
Affiliation(s)
- Jia-Rong Wu
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina, USA.
| | | | | | | | | |
Collapse
|
19
|
Vardeny O, Cavallari LH, Claggett B, Desai AS, Anand I, Rossignol P, Zannad F, Pitt B, Solomon SD. Race Influences the Safety and Efficacy of Spironolactone in Severe Heart Failure. Circ Heart Fail 2013; 6:970-6. [DOI: 10.1161/circheartfailure.113.000530] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Orly Vardeny
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Larisa H. Cavallari
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Brian Claggett
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Akshay S. Desai
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Inder Anand
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Patrick Rossignol
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Faiez Zannad
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Bertram Pitt
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| | - Scott D. Solomon
- From the University of Wisconsin School of Pharmacy, Madison, WI (O.V.); University of Illinois at Chicago, IL (L.H.C.); Brigham and Women’s Hospital, Boston, MA (B.C., A.S.D., S.D.S.); University of Minnesota, Minneapolis, MN (I.A.); INSERM, Centre d’Investigations Cliniques-9501 and INSERM U961, Université de Lorraine, Nancy, France (P.R., F.Z.); and University of Michigan, Ann Arbor, MI (B.P.)
| |
Collapse
|
20
|
Heckman BD, Ellis G. Preventive medication adherence in African American and Caucasian headache patients. Headache 2013; 51:520-32. [PMID: 21457237 DOI: 10.1111/j.1526-4610.2011.01866.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
STUDY OBJECTIVES To examine race-related differences in adherence to preventive medication agents in headache patients and identify factors predictive of medication adherence in Caucasian and African American headache patients. METHODS Using a longitudinal naturalistic study design, data from 77 Caucasian and 32 African American headache patients were collected through (1) 30-day daily diaries that assessed medication adherence, headache frequency, and headache episode severity; (2) self-administered surveys that assessed headache management self-efficacy; and (3) telephone-administered psychiatric interviews that yielded psychiatric diagnoses. Using daily diary adherence data, patients' adherence to preventive agents was dichotomized as "Inconsistent" (ie, adhered fewer than 80% of days) or "Consistent" (ie, adhered ≥ 80% of days during the past month). RESULTS The proportion of adherent African American patients (69%) did not differ significantly from the proportion of adherent Caucasian patients (82%). Exploratory univariate logistic regression analyses found that preventive medication adherence levels of 80% or less were associated with being diagnosed with major depressive disorder and lower levels of headache management self-efficacy. CONCLUSIONS Future research should test if interventions that reduce depressive symptoms and increase patients' levels of headache management self-efficacy can produce concomitant increases in adherence to preventive headache agents.
Collapse
|
21
|
Abstract
Cardiovascular disease is a major, growing, worldwide problem. It is important that individuals at risk of developing cardiovascular disease can be effectively identified and appropriately stratified according to risk. This review examines what we understand by the term risk, traditional and novel risk factors, clinical scoring systems, and the use of risk for informing prescribing decisions. Many different cardiovascular risk factors have been identified. Established, traditional factors such as ageing are powerful predictors of adverse outcome, and in the case of hypertension and dyslipidaemia are the major targets for therapeutic intervention. Numerous novel biomarkers have also been described, such as inflammatory and genetic markers. These have yet to be shown to be of value in improving risk prediction, but may represent potential therapeutic targets and facilitate more targeted use of existing therapies. Risk factors have been incorporated into several cardiovascular disease prediction algorithms, such as the Framingham equation, SCORE and QRISK. These have relatively poor predictive power, and uncertainties remain with regards to aspects such as choice of equation, different risk thresholds and the roles of relative risk, lifetime risk and reversible factors in identifying and treating at-risk individuals. Nonetheless, such scores provide objective and transparent means of quantifying risk and their integration into therapeutic guidelines enables equitable and cost-effective distribution of health service resources and improves the consistency and quality of clinical decision making.
Collapse
Affiliation(s)
- Rupert A Payne
- General Practice and Primary Care Research Unit, University of Cambridge, UK.
| |
Collapse
|
22
|
Granger BB, McBroom K, Bosworth HB, Hernandez A, Ekman I. The meanings associated with medicines in heart failure patients. Eur J Cardiovasc Nurs 2012; 12:276-83. [PMID: 22653088 DOI: 10.1177/1474515112447734] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The purpose of this study was to explore the theoretical linkages between symptom experiences and meaning associated with medication adherence. The specific objectives were to evaluate the key constructs of Meaning-Response theory for understanding medication adherence in patients with chronic heart failure; to assess the influence of symptom persistence on the meaning associated with prescribed medicines; and to explore the extent to which meaningful associations improve medication adherence. Among patients with heart failure, poor medication adherence occurs in over half of the population, resulting in high rates of symptom exacerbation, avoidable hospitalization, and death. Nurses play a key role in facilitating self-management skills, but patients' perceptions of the relationship between symptoms and medicines is not clear. METHODS Using a prospective mixed methods design, the study assessed patients' (n=10) perception of chronic heart failure symptoms and medication adherence. Patients completed guided interviews related to six concepts of meaning ascribed to medication use and four standardized measures of medication-related beliefs, behaviours, symptoms, and satisfaction. RESULTS This study suggests that patients' perception of meaning associated with medication taking was categorized as positive, negative, or absent. Symptom persistence influenced a majority of patient beliefs in the efficacy medicines, and patients with more positive meaningful associations with their medicines were more likely to remain adherent during the course of this study. CONCLUSIONS Development of meaningful associations with medicines may improve long-term adherence with prescribed medication in heart failure.
Collapse
|
23
|
Roberts SR, Crigler J, Lafferty WE, Bonham AJ, Hunter JL, Smith AJ, Banderas JW, Early GL, King RK. Addressing Social Determinants to Improve HealthCare Quality and Reduce Cost. J Healthc Qual 2012; 34:12-20. [DOI: 10.1111/j.1945-1474.2011.00179.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
24
|
Abstract
PURPOSE OF REVIEW Adherence to proven, effective medications remains low, resulting in high rates of clinical complications, hospital readmissions, and death. The use of technology to identify patients at risk and to target interventions for poor adherence has increased. This review focuses on research that tests these emerging technologies and evaluates the effect of technology-based adherence interventions on cardiovascular outcomes. RECENT FINDINGS Recent studies have evaluated technology-based interventions to improve medication adherence by using pharmaceutical databases, tailoring educational information to individual patient needs, delivering technology-driven reminders to patients and providers, and integrating in-person interventions with electronic alerts. Cellular phone reminders and in-home electronic technology used to communicate reminder messages have shown mixed results. Only one study has shown improvement in both adherence and clinical outcome. Current trials suggest that increasing automated reminders will complement but not replace the benefits seen with in-person communication for medication taking. SUMMARY Integration of in-person contacts with technology-driven medication adherence reminders, electronic medication reconciliation, and pharmaceutical databases may improve medication adherence and have a positive effect on cardiovascular clinical outcomes. Opportunities for providers to monitor the quality of care based on new adherence research are evolving and may be useful as standards for quality improvement emerge.
Collapse
|
25
|
Wu JR, Lennie TA, Chung ML, Frazier SK, Dekker RL, Biddle MJ, Moser DK. Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure. Heart Lung 2011; 41:107-14. [PMID: 22054720 DOI: 10.1016/j.hrtlng.2011.09.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 09/01/2011] [Accepted: 09/12/2011] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Prognosis is worse in unmarried patients compared with married patients with heart failure (HF). The reasons for differences in outcomes are unclear, but variations in medication adherence may play a role, because medication adherence is essential to achieving better outcomes. The study objective was to determine whether medication adherence mediated the relationship between marital status and cardiac event-free survival in patients with HF. METHODS Demographic, clinical, and psychosocial data were collected by questionnaires and medical record review for 136 patients with HF (aged 61 ± 11 years, 70% were male, 60% were in New York Heart Association class III/IV). Medication adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Cardiac event-free survival data were obtained by patient/family interview, hospital database, and death certificate review. A series of regression and Cox survival analyses were performed to determine whether medication adherence mediated the relationship between marital status and event-free survival. RESULTS Cardiac event-free survival was worse in unmarried patients than in married patients. Unmarried patients were more likely to be nonadherent and 2 times more likely to experience an event than married patients (P = .017). Marital status was not a significant predictor of event-free survival after entering medication adherence in the model, demonstrating a mediation effect of adherence on the relationship of marital status to survival. CONCLUSION Medication adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase medication adherence that take into account subgroups, such as unmarried patients, who are at higher risk for nonadherence.
Collapse
Affiliation(s)
- Jia-Rong Wu
- University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina 27599-7460, USA.
| | | | | | | | | | | | | |
Collapse
|
26
|
The Relationship Between Self-concept and Adherence to Therapeutic Regimens in Patients With Heart Failure. J Cardiovasc Nurs 2011; 26:475-80. [DOI: 10.1097/jcn.0b013e318215bb78] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
27
|
Izzo JL, Zion AS. Combined aliskiren-amlodipine treatment for hypertension in African Americans: clinical science and management issues. Ther Adv Cardiovasc Dis 2011; 5:169-78. [PMID: 21606125 DOI: 10.1177/1753944711409615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
While it may seem at first that antihypertensive drug combinations run counter to the desire to 'personalize' the management of hypertension, the best combinations have predictable efficacy in different individuals and subpopulations. Race is probably not a valid surrogate for clinically meaningful genetic variation or guide to therapy. Most guidelines suggest similar blood pressure goals for different races but drug treatment recommendations have diverged. In the United States, race is not considered to be a major factor in drug choice, but in England and other countries, initial therapy with renin-angiotensin system blocking drugs is not recommended in Blacks. In this review we: (1) examine new trends in race-based research; (2) emphasize the weaknesses of race-based treatment recommendations; and (3) explore the effects of a new combination, renin inhibition (aliskiren) and amlodipine, in African Americans.
Collapse
Affiliation(s)
- Joseph L Izzo
- Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 462 Grider Street, Buffalo, NY 14215, USA.
| | | |
Collapse
|
28
|
Konstam MA, Konstam V. Heart Failure Disease Management. J Am Coll Cardiol 2010; 56:379-81. [DOI: 10.1016/j.jacc.2010.04.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 04/16/2010] [Accepted: 04/21/2010] [Indexed: 11/30/2022]
|
29
|
Ethnicity and Medication Adherence: Factors That Need to be Taken Into Account. J Card Fail 2010; 16:619. [DOI: 10.1016/j.cardfail.2010.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2010] [Indexed: 11/21/2022]
|