Association of depression and anxiety with adherence in primary care patients with heart failure-cross-sectional results of the observational RECODE-HF cohort study

A predictive model for medication adherence in older adults with heart failure

AIMS

Although many studies have examined the predictors of medication adherence (MA), further empirical research is required to clarify the best model for predicting MA for older adults with heart failure (HF). Thus, we hypothesized a model in which information (knowledge), motivation (social support and depressive symptoms), and behavioural skills (barriers to self-efficacy) would be associated with MA in patients with HF.

METHODS AND RESULTS

Using a cross-sectional survey, 153 adults aged ≥ 65 years taking medication for HF were recruited from a university hospital in Korea. Data were collected based on the information-motivation-behavioural skills (IMB) model constructs and MA. In the hypothesized path model, self-efficacy was directly related to MA (β = -0.335, P = 0.006), whereas social support was indirectly related to MA through self-efficacy (β = -0.078, P = 0.027). Depressive symptoms were directly related to MA (β = 0.359, P = 0.004) and indirectly related to MA through self-efficacy (β = 0.141, P = 0.004). The hypothesized MA model showed a good fit for the data. Knowledge, social support, and depressive symptoms accounted for 44.3% of the variance in self-efficacy (P = 0.004). Left ventricular ejection fraction, knowledge, social support, depressive symptoms, and self-efficacy explained 64.4% of the variance in MA (P = 0.004).

CONCLUSION

These results confirmed the IMB model's suitability for predicting MA in older adults with HF. These findings may guide and inform intervention programmes designed to alleviate depressive symptoms in older adults with HF and enhance their HF knowledge, social support, and self-efficacy, with the ultimate goal of improving their MA.

Assessing the diversity and determinants of health-related quality of life measures in patients with acute heart failure

AIMS

Heart failure with reduced ejection fraction (HFrEF) significantly impacts health-related quality of life (HR-QoL). Existing HR-QoL questionnaires can show inconsistencies, potentially misrepresenting patient self-reports. This study examines the variation in HR-QoL measurement tools for HFrEF patients, identifying related determinants.

METHODS AND RESULTS

We retrospectively analysed 134 hospitalized patients with acute decompensated HFrEF at a Taiwanese tertiary centre's Heart Failure Post-Acute-Care (HF-PAC) programme. Participants completed the EuroQol-5 dimension (EQ-5D) questionnaire, the EQ-5D visual analogue scale (VAS), and the Minnesota Living with Heart Failure Questionnaire (MLHFQ). Utility values were obtained from the EQ-5D questionnaire. Demographic features were depicted using descriptive statistics, while multivariate regression was used to ascertain relationships between HR-QoL measurements and determinants. Average scores for EQ-5D, MLHFQ, EQ-5D utility, and VAS were 6.1 ± 1.6, 21.8 ± 21.3, 81.7 ± 27.0, and 59.5 ± 14.6, respectively. Significant correlations were observed among the three tools. The New York Heart Association functional class showed a notable association with all tool scores. Other associations encompassed EQ-5D with coronary artery disease, mineralocorticoid receptor antagonists, and the 6 min walk test; EQ-5D VAS with chronic kidney disease; and MLHFQ with age.

CONCLUSIONS

This study illuminates the variance in HR-QoL measurement tools for Taiwanese HFrEF patients. Using a range of these tools is beneficial in unveiling diverse determinants and approaching comprehensive patient-centred care. However, for a more precise HR-QoL assessment in Taiwanese HFrEF patients, recalibrating the EQ-5D-derived utility scores might be necessary, emphasizing the importance of patient-specific considerations within the HF-PAC programme.

Feasibility of a brief, in-patient coping and sleep intervention to reduce potentially preventable readmission of cardiac patients to hospital

Background

Psychological distress is prevalent amongst hospital in-patient and may predispose patients to potentially preventable readmissions after discharge. A particularly vulnerable group are patients with cardiac disorders. This study tested the feasibility of a brief cognitive behavioural therapy consisting of an in-hospital coping session and a post-discharge healthy sleep session.

Methods

Standardised questionnaire were used to assess sleep, coping/distress and wellbeing at baseline (pre-intervention) and one-month post-discharge (post-intervention). Treatment fidelity and acceptability were assessed at follow-up. Participants included 72 inpatients admitted with a cardiac disorder or reported to have a cardiac problem whilst in hospital from a single Australian public hospital.

Results

Most (83 %) participants found the intervention helpful/very helpful. At baseline prior to admission, almost half of participants (46 %) reported poor wellbeing, 19 % high levels of distress and poor coping, and 47 % sleeping less than 7 h per night. Following the intervention, 45 % of participants with poor wellbeing at baseline had reliable change in wellbeing at follow-up. Conversely, only 22 % of patients with high levels of coping/distress at baseline demonstrated improved coping/distress at follow-up suggesting smaller gains. On average a large 43 min gain in sleep duration was observed post-treatment in patients with poor sleep at baseline. Fourteen percent of participants were readmitted to hospital within 34-days of discharge.

Conclusions

The coping and sleep intervention was well received with positive outcomes in patients especially those reporting high levels of distress for sleep and to lesser extent coping and wellbeing. Future studies to assess the efficacy of the brief intervention at reducing hospital readmissions are needed.

Low body mass index and disease duration as factors associated with depressive symptoms of Chinese inpatients with chronic heart failure

Depression is common in patients with chronic heart failure (CHF), and is associated with an increased risk of adverse health outcomes. There is a paucity of data on this subject from the developing countries. The aim was to examine the prevalence and related factors of depressive symptoms among Chinese inpatients with CHF. A cross-sectional study was conducted. PHQ-9 questionnaire was used to assess depressive symptoms. The overall prevalence of depressive symptoms was 7.5%. Low BMI (OR = 4.837, CI = 1.278-18.301, p = 0.02), disease duration 3-5 years (OR = 5.033, CI = 1.248-20.292, p = 0.023) and 5-10 years (OR = 5.848, CI = 1.440-23.744, p = 0.013) were risk factors for depressive symptoms, while being married (OR = 0.304, CI = 0.123-0.753, p = 0.010) was protective factor. We should pay more attention to patients without a spouse, with low BMI and whose disease duration is between 3 and 10 years in Chinese inpatients with CHF.

Effect of e-health intervention on disease management in patients with chronic heart failure: A meta-analysis

Objective

The aim of this meta-analysis was to assess the impact of e-health interventions on disease management in patients with CHF.

Methods

Six databases including Embase, Web of Science, Scopus, PubMed, Cochrane, and EBSCO were searched by computer. The search time is before May 1, 2022. Odds ratios (OR) were used for binary categorical data and weighted mean differences (WMD) for continuous variables. The 95% confidence intervals (CI) were used to express the effect sizes for both count and measurement data. RevMan 5.4 and Stata 16.0 were employed to complete this meta-analysis.

Results

The study included 22 research studies and 5,149 patients. e-health intervention can effectively reduce all-cause mortality [OR = 0.801, 95%CI: (0.650, 0.987), P < 0.05], all-cause hospitalization rate [OR = 0.66, 95%CI: (0.46, 0.95), P < 0.05] and heart failure related hospitalization rate [OR = 0.750, 95%CI: (0.632, 0.891), P < 0.05]. e-health intervention is also effective in improving the quality of life [WMD = 2.97, 95%CI: (1.54, 4.40), P < 0.05] and the self-management ability of patients [WMD = -2.76, 95%CI: (-5.52, -0.11), P < 0.05].

Conclusion

e-health interventions can reduce all-cause mortality, all-cause hospitalization, and heart failure-related hospitalization in patients with CHF. Furthermore, it can improve the health-related quality of life of patients.

Relationship between self-efficacy and adherence to self-management and medication among patients with chronic diseases in China: A multicentre cross-sectional study

PURPOSE

This study aimed to explore the effects of self-efficacy on adherence to self-management and medication among patients with chronic diseases in China.

METHODS

A cross-sectional survey of 2047 patients with chronic diseases in 120 cities across China was conducted between May and September 2021 using a multi-stage sampling method. Self-efficacy was measured using the New General Self-Efficacy Scale. The adherence to self-management was measured using the item response theory based self-management adherence scale, and the medication adherence was assessed using the Medication Adherence Scale for the Chronically Ill. The adherence to self-management and medication were evaluated by linear regression and logistic regression models, respectively.

RESULTS

After adjusting for all covariates, self-efficacy was significantly associated with adherence to self-management (β =0.207, 95% CI =0.064-0.350, P = 0.005), but not with medication adherence (for[middle/low]: OR = 1.119, 95% CI =0.828-1.511, P = 0.47; for[high/low]: OR = 1.281, 95% CI =0.935-1.754, P = 0.12). In subgroup analysis, self-efficacy positively correlated with adherence to self-management in patients with multiple chronic diseases (β =0.286, 95% CI =0.037-0.535, P = 0.03), but not in those with only one chronic disease (P = 0.12). Self-efficacy was not significantly associated with medication adherence in any of the subgroups.

CONCLUSION

Self-efficacy was positively associated with adherence to self-management in patients with chronic diseases, but not with medication adherence. Enhanced health education in patients with one chronic disease alone may have an association with better adherence to self-management and medication in daily life.

The Role of Depression on Treatment Adherence in Patients with Heart Failure-a Systematic Review of the Literature

INTRODUCTION

Although poor medication adherence is considered an impacting risk factor for worsening heart failure (HF) outcomes, adherence rates in HF patients continue to be considerably low. To improve this condition, several studies investigated the impact of many determinants on medication adherence; however, few authors explored the role of depression on it.

PURPOSE OF REVIEW

The purpose of this systematic review was to explore the association between depressive symptoms and medication adherence in HF patients. In particular, the research question was is depression a barrier to medication adherence in HF patients?

METHODS

A systematic review of quantitative analysis studies was undertaken. Six electronic databases were searched between the end of October and March 2022. Thirty-one trials were included, all of them assessed depression, adherence to medication, and their possible relationship.

RESULTS

As was intended, findings showed that the impact of a mild to moderate level of depression was significant on adherence to treatment in HF patients. However, many other risk factors emerged, like family support and health practices (es. low sodium diet).

CONCLUSION

The detection of depression in the setting of HF should be crucial to HF patients' physical health and quality of life. Future research should take depression into account, exploring this area through self-report and qualitative interview as well.

Prognostic factors associated with quality of life in heart failure patients considering the use of the generic EQ-5D-5L™ in primary care: new follow-up results of the observational RECODE-HF study

BACKGROUND

The implementation of care concepts fitting the needs of patients with chronic heart failure (HF) remains challenging. In this context, psycho-emotional well-being is not routinely assessed, and under-researched despite indications that it is of great relevance for, e.g., acceptance, adherence, and prognosis. The aim of this study was to observe clinical characteristics for their prognostic utility in HF patients, and to compare the patients' health-related quality of life (QoL) with German population norm values.

METHODS

The current post-hoc analysis was performed on data collected amongst participants of the RECODE-HF study who had fully answered the EQ-5D-5L™ items at both baseline and 12 months (n = 2354). The status in the patients' self-assessment items, EQ-5D visual analog scale (VAS) and EQ-5D index was categorized into worse/unchanged/improved. General linear mixed models (GLMM) with logit link were applied. Subgroups included 630 patients (26.8%) screened positive and 1724 patients (73.2%) screened negative for psychosocial distress (PSD).

RESULTS

The 12-months change in EQ-5D index, generally resulting from change in individual EQ-5D items, additionally associated not only with high NYHA class but sociodemographics (employment/living alone/GP practice years) (96.2% correctly classified in GLMM). The 12- months change in individual QoL aspects showed associations with age*NYHA, gender, body-mass index, and comorbidities dyslipidemia, myocardial infarction, asthma/chronic pulmonary disease. Important social roles were reflected in particular when HF patients lived alone or the doctor mentioned to the patient that the patient had HF. Patients with/without PSD differed in some sociodemographic and clinical parameters. However, no influence of PSD could be demonstrated in the 12-month follow-up of the EQ-5D-5L™. Nonetheless, comparison of the 12-months QoL with general German population norm values by age groups < 75 years and 75+ showed markedly health restrictions in HF patients in all EQ-5D-5L™ aspects.

CONCLUSION

Our analysis revealed different prognostic factors primarily associated with change of burden in different QoL aspects in HF patients. In GP practice it is important to consider in addition to the overall day-related VAS all the individual health-related QoL aspects to take a holistic view of the patient, as well as to pay particular attention to the interrelation of individual characteristics.

Patient-centered Outcomes in HFrEF Following a Worsening Heart Failure Event: A Survey Analysis

BACKGROUND

Heart failure is a chronic disease punctuated by intermittent exacerbations that require hospitalization or intravenous diuretic therapy. The association of worsening heart failure events (WHFEs) with patient-centered outcomes in heart failure with reduced ejection fraction (HFrEF) remains unexplored.

METHODS AND RESULTS

Patients with HFrEF completed an online survey assessing health status, medication adherence, treatment satisfaction, treatment burden, and medication costs and affordability. Patients with and without WHFEs were compared on all study variables, with adjustment for patient characteristics using linear or logistic regression. Overall, 512 patients (52.0% WHFEs) were included. Patients with WHFEs more commonly had depression (55.3% vs 24.0%), anxiety (46.2% vs 17.9%), and insomnia (77.8% vs 44.7%; P < 0.001 for all). Patients with WHFEs had lower adjusted mean Kansas City Cardiomyopathy Questionnaire values (52.9 vs 56.0) and Satisfaction with Medications Questionnaire values (70.5 vs 72.6) and higher Treatment Burden Questionnaire scores (51.1 vs 45.1; P < 0.001). Medication-related beliefs and long-term concerns were independently associated with nonadherence in patients with WHFE (adjusted odds ratios: 4.2 and 5.2, respectively; P < 0.01 for both). Patients with WHFE incurred 50.0% higher median monthly out-of-pocket HF prescription medication costs and less often perceived HF medications to be affordable.

CONCLUSIONS

WHFE is associated with several adverse impacts on patients with HFrEF. Additional support is warranted to manage symptoms, comorbidities, and HF treatments to improve adherence and outcomes.