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Huber M, Busch AK, Stalder-Ochsner I, Flammer AJ, Schmid-Mohler G. Medication adherence in adults after hospitalization for heart failure: A cross-sectional study. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200234. [PMID: 38299126 PMCID: PMC10828571 DOI: 10.1016/j.ijcrp.2023.200234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/19/2023] [Accepted: 12/21/2023] [Indexed: 02/02/2024]
Abstract
Background Medication non-adherence in heart failure (HF) leads to increased mortality, morbidity and healthcare costs. However, no study has investigated HF patients' post-hospitalization medication non-adherence in Switzerland. Objectives Our primary aim was to assess the prevalence of post-discharge medication non-adherence in patients with HF. A secondary objective was to identify differences between fully and partially adherent patients regarding selected unplanned therapy-related inpatient/outpatient cardiology visits. Methods A non-experimental cross-sectional study was applied. The prevalence of medication adherence was assessed with a German-translated version of the Medication Adherence Report Scale (MARS-5) and analyzed descriptively. Differences between adherent and partially adherent patients' numbers of medications, dosing per day and 180-day unplanned inpatient stays or cardiology outpatient visits were explored. Results Of 153 recruited patients, 72 participated in the survey. Of these, 26.4 % were not fully adherent. Their most common reason was forgetfulness (23.7 %). There were no significant group differences regarding therapy-related variables or 180-day unplanned cardiology stays/visits. Conclusions Considering that over one-quarter of surveyed HF patients were not fully medication adherent, Swiss cardiology nurses need to be sensitized to this issue and trained in adherence-enhancing interventions. Reaching acceptable adherence levels in patients with HF will require further research and action.
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Affiliation(s)
- Manuela Huber
- Educational Center for Health and Social, Weinfelden, Switzerland
- Clinic for General, Visceral, Transplant, Vascular and Thoracic Surgery, Cantonal Hospital St. Gallen, Switzerland
| | - Ada Katrin Busch
- Institute of Nursing, ZHAW School of Health Science, Winterthur, Switzerland
| | - Irene Stalder-Ochsner
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Andreas J. Flammer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Gabriela Schmid-Mohler
- Center of Clinical Nursing Science, University Hospital Zurich, Switzerland
- Department of Pulmonology, University Hospital Zurich, Switzerland
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Chen Y, Gao J, Lu M. Medication adherence trajectory of patients with chronic diseases and its influencing factors: A systematic review. J Adv Nurs 2024; 80:11-41. [PMID: 37408103 DOI: 10.1111/jan.15776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 06/16/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
AIMS To synthesize the published studies on medication adherence trajectories among patients with chronic diseases and identify the influencing factors. DESIGN Systematic review. DATA SOURCES Medline (Ovid), Embase (Ovid) and Web of Science core collection were searched from database inception to 1 July 2022. REVIEW METHODS Potentially eligible articles were independently screened by three reviewers using set inclusion and exclusion criteria. The Joanna Briggs Institute critical appraisal checklist for cohort studies was used to appraise the quality of the included articles. Three reviewers independently evaluated the quality, extracted data and resolved differences by consensus. Results were presented using descriptive synthesis, and the prevalence of recategorised medication adherence trajectories was calculated from the published data. RESULTS Fifty studies were included. Medication adherence trajectories among patients with chronic diseases were synthesized into six categories: adherence, non-adherence, decreasing adherence, increasing adherence, fluctuating adherence and moderate adherence. Low and moderate evidence showed that (1) patient-related factors, including age, sex, race, marital status and mental status; (2) healthcare team and system-related factors, including healthcare utilization, insurance and primary prescriber specialty; (3) socioeconomic factors including education, income and employment status; (4) condition-related factors including complications and comorbidities and (5) therapy-related factors including the number of medications, use of other medications, and prior medication adherence behaviours were factors influencing the medication adherence trajectory. Marital status and prior medication adherence behaviour were the only influencing factors with moderate evidence of an effect. CONCLUSION The medication adherence trajectory among patients with chronic diseases varied widely. Further studies are warranted to determine contributory factors. IMPLICATIONS FOR THE PROFESSION Healthcare providers should be aware that patients' medication adherence has different trajectories and should take appropriate measures to improve patients' medication adherence patterns. PATIENT OR PUBLIC CONTRIBUTION None. As a systematic review, patients and the public were not involved.
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Affiliation(s)
- Yu Chen
- School of Nursing, Fudan University, Shanghai, China
| | - Jing Gao
- Clinical Research Institute, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Minmin Lu
- School of Nursing, Fudan University, Shanghai, China
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3
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Mwita JC, Joubert A, Saidu H, Sani MU, Damasceno A, Mocumbi AO, Sinxadi P, Viljoen CA, Hoevelmann J, Gebreyesus MS, Denti P, Wasmann R, Maartens G, Wiesner L, Stewart S, Davison B, Cotter G, Sliwa K. Objectively measured medication adherence using assays for carvedilol and enalaprilat in patients with heart failure in Mozambique and Nigeria. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 19:200213. [PMID: 37811486 PMCID: PMC10556761 DOI: 10.1016/j.ijcrp.2023.200213] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/22/2023] [Accepted: 09/07/2023] [Indexed: 10/10/2023]
Abstract
Background Poor medication adherence leads to poor health outcomes and increased healthcare costs among patients with heart failure (HF). This study aimed to objectively assess medication adherence by measuring carvedilol and enalaprilat plasma concentrations among patients with HF. Methods The present sub-study of the Safety, Tolerability, and Efficacy of Rapid Optimization, helped by NT-proBNP testing, of Heart Failure therapies (STRONG-HF) study involved adult patients with acute HF admitted in two Mozambican and two Nigerian hospitals who were not optimally treated with oral enalapril and carvedilol. Patients in the high-intensity arm of the STRONG-HF study, and those not meeting the biomarker criteria for persistent congestion, were included in the "frequent visit" (FV) arm. In the FV arm, blood for bioanalysis of plasma enalaprilat or/and carvedilol was drawn at the 2,6,12th week post-discharge. Patients in the usual care arm of STRONG-HF were included in the "standard visit" (SV) arm, which followed the usual local practice with blood sampling in week 12. Results The study involved 113 (79 FV and 34 SV) participants with a mean age of 48.6 years and a mean left ventricular (LV) ejection fraction of 33.1%. Theenalaprilat below the lower level of quantification (LLOQ) was documented in 7.7%, 11.9%, and 15.6% of participants in FV during the 2,6 and 12th weeks. Carvedilol concentration below LLOQ was documented in 37%, 30%, and 44.4% of participants in the FV arm during the 2,6 and 12th weeks, respectively. For the SV arm, enalaprilat and carvedilol concentrations below LLOQ in the twelfth week were documented in 37.3% and 42.9% of patients, respectively. Conclusion Up to a third of patients using enalapril and carvedilol did not take any medication during the 12 weeks of follow-up. Non adherence was more common in patients who had less follow up, emphasizing the importance of close follow up to adherence. No adherence was also more common in medications know to have more side effects such as carvedilol.
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Affiliation(s)
- Julius Chacha Mwita
- Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Andre Joubert
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Hadiza Saidu
- Department of Medicine Bayero University Kano & Murtala Muhammed Specialist Hospital, Kano, Nigeria
| | - Mahmoud Umar Sani
- Department of Medicine, Bayero University Kano & Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Research Unit, Department of Medicine, Maputo Central Hospital, Maputo, Mozambique
| | - Ana Olga Mocumbi
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Instituto Nacional de Saúde, Vila de Marracuene, Mozambique
| | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- SAMRC/UCT Platform for Pharmacogenomics Research and Translation, South African Medical Research Council, Cape Town, South Africa
| | - Charle Andre Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Julian Hoevelmann
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Department of Internal Medicine III - Cardiology, Angiology and Intensive Care Medicine, Saarland University Hospital, Homburg, Germany
| | - Manna Semere Gebreyesus
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Roeland Wasmann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Simon Stewart
- Faculty of Medicine, Eduardo Mondlane University, Maputo, Mozambique
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
- School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Beth Davison
- Momentum Research, Inc., Chapel Hill, NC, USA
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Gad Cotter
- Momentum Research, Inc., Chapel Hill, NC, USA
- Inserm UMR-S 942, Cardiovascular Markers in Stress Conditions (MASCOT), Université de Paris, Paris, France
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Arapi A, Vellone E, Ivziku D, Duka B, Taci D, Notarnicola I, Stievano A, Prendi E, Rocco G, De Maria M. Psychometric Characteristics of the Self-Care of Chronic Illness Inventory in Older Adults Living in a Middle-Income Country. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4714. [PMID: 36981630 PMCID: PMC10048512 DOI: 10.3390/ijerph20064714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/24/2023] [Accepted: 03/02/2023] [Indexed: 06/18/2023]
Abstract
Chronic illness requires numerous treatments and self-care is essential in the care process. Evaluation of self-care behaviors facilitates the identification of patients' needs and optimizes education and care processes. This study aimed to test the psychometric characteristics (validity, reliability, and measurement error) of the Albanian version of the Self-Care of Chronic Illness Inventory (SC-CII). Patients with multiple chronic conditions and caregivers were recruited in outpatient clinics in Albania. The patients completed the SC-CII, which includes three scales: self-care maintenance, self-care monitoring, and self-care management. Factorial validity was tested for each scale, with confirmatory factor analysis. Reliability was evaluated with the composite coefficient, Cronbach's alpha, and the global reliability index for multidimensional scales. The construct validity was tested using hypothesis testing and known differences between groups. The measurement error was tested to assess responsiveness to changes. The self-care maintenance and self-care monitoring scales showed a unidimensional factorial structure, while the self-care management scale showed a bidimensional structure. Reliability estimates were adequate for all reliability coefficients. Construct validity was supported. The measurement error was adequate. The Albanian version of the SC-CII shows good psychometric properties in the Albanian sample.
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Affiliation(s)
- Alta Arapi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Dhurata Ivziku
- Degree Course in Nursing, UniCamillus International Medical University, 00131 Rome, Italy
- Department of Healthcare Professions, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy
| | - Blerina Duka
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Dasilva Taci
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Ippolito Notarnicola
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Alessandro Stievano
- Centre of Excellence for Nursing Scholarship, Order of Nurses of Rome, 00173 Rome, Italy
- Department of Clinical and Experimental Medicine, University of Messina, 98100 Messina, Italy
| | - Emanuela Prendi
- Department of Biomedical Sciences, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
| | - Gennaro Rocco
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
- Centre of Excellence for Nursing Scholarship, Order of Nurses of Rome, 00173 Rome, Italy
| | - Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy
- Degree Course in Nursing, Catholic University “Our Lady of Good Counsel”, 1000 Tirana, Albania
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Lip GYH, Genaidy A, Jones B, Tran G, Estes C, Sloop S. Medication non-adherence patterns and profiles for patients with incident myocardial infarction: Observations from a large multi-morbid US population. Eur J Clin Invest 2023; 53:e13968. [PMID: 36789887 DOI: 10.1111/eci.13968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 02/06/2023] [Accepted: 02/09/2023] [Indexed: 02/16/2023]
Abstract
BACKGROUND Consistent adherence levels to multiple long-term medications for patients with cardiovascular conditions are typically advocated in the range of 50% or higher, although very likely to be much lower in some populations. We investigated this issue in a large cohort covering a broad age and geographical spectrum, with a wide range of socio-economic disability status. METHODS The patients were drawn from three different health plans with a varied mix of socio-economic/disability levels. Adherence patterns were examined on a monthly basis for up to 12 months past the index date for myocardial infarction (MI) using longitudinal analyses of group-based trajectory modelling. Each of the non-adherent patterns was profiled from comorbid history, demographic and health plan factors using main effect logistic regression modelling. Four medication classes were examined for MI: betablockers, statin, ACE inhibitors and anti-platelets. RESULTS The participant population for the MI/non-MI cohorts was 1,987,605 (MI cohort: mean age 62 years, 45.9% female; non-MI cohort: mean age 45 years, 55.3% females). Cohorts characterized by medication non-adherence dominated the majority of MI population with values ranging from 74% to 82%. There were four types of consistent non-adherence patterns as a function of time for each medication class: fast decline, slow decline, occasional users and early gap followed by increased adherence. The characteristics of non-adherence profiles eligible for improvement included patients with a prior history of hypertension, diabetes mellitus and stroke as co-morbidities, and Medicare plan. CONCLUSIONS We found consistent patterns of intermediate non-adherence for each of four drug classes for MI cohorts in the order of 56% who are eligible for interventions aimed at improving cardiovascular medication adherence levels. These insights may help improve cardiovascular medication adherence using large medication non-adherence improvement programs.
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Affiliation(s)
- Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | | | - Bobby Jones
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | | | | | - Sue Sloop
- Anthem Inc., Indianapolis, Indiana, USA
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Redeker NS, Conley S, Hwang Y. Sleep Deficiency: A Symptoms Perspective: Exemplars from Chronic Heart Failure, Inflammatory Bowel Disease, and Breast Cancer. Clin Chest Med 2022; 43:217-228. [PMID: 35659020 PMCID: PMC9178708 DOI: 10.1016/j.ccm.2022.02.006] [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] [Indexed: 11/03/2022]
Abstract
Sleep deficiency is associated with disabling daytime symptoms, including excessive daytime sleepiness (EDS) and fatigue. The purpose of this article is to discuss the contributions of sleep deficiency and sleep disorders to fatigue and EDS among people with chronic conditions. We use exemplars from the literature on chronic heart failure, inflammatory bowel disease, and breast cancer to (1) describe the prevalence of fatigue and EDS and their consequences; (2) examine the evidence for the contributions of sleep deficiency and sleep disorders to these symptoms; and (3) recommend implications for future research and practice.
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Affiliation(s)
- Nancy S Redeker
- UCONN School of Nursing, Yale University, University of Connecticut School of Nursing, 231 Glenbrook Road, Unit 4026, Storrs, CT 06269-4026, USA.
| | - Samantha Conley
- Nursing Research Division, Department of Nursing, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Youri Hwang
- Yale School of Nursing, PO Box 27399, West Haven, CT 06516-0972, USA
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7
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The Association Between Self-reported Sleep Quality and Self-care in Adults With Heart Failure. J Cardiovasc Nurs 2022; 38:E98-E109. [PMID: 37027137 DOI: 10.1097/jcn.0000000000000929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sleep disturbance is one of the most common symptoms among patients with heart failure (HF), and it may affect the ability of patients to perform self-care. There is a lack of evidence on the association between sleep quality and its components and self-care in adults with HF. OBJECTIVE The aim of this study was to evaluate the association between sleep quality and its components and self-care in adults with HF. METHODS This study is a secondary analysis of baseline data from the MOTIVATE-HF study, a randomized controlled trial on patients with HF and their caregivers. Only patients' data were analyzed in this study (n = 498). Sleep quality and self-care were evaluated with the Pittsburgh Sleep Quality Index and the Self-Care of Heart Failure Index v6.2, respectively. RESULTS A habitual sleep efficiency of 75% to 84% was associated with lower self-care maintenance compared with a habitual sleep efficiency of 85% or greater ( P = .031), as was taking sleep medications once or twice a week compared with less than once a week ( P = .001). A frequency of daytime dysfunction less than once a week was associated with lower self-care management compared with a frequency of daytime dysfunction of 3 or more times a week ( P = .025). Taking sleep medications less than once a week was associated with lower self-care confidence compared with taking sleep medications 3 or more times a week ( P = .018). CONCLUSION Poor sleep quality is frequently reported by patients with HF. Sleep efficiency, sleep medications, and daytime dysfunction may influence self-care more than the other sleep quality components.
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8
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Skoufalos A, N'Dri LA, Waters D. Leveraging Digital Medicine to Support Providers and Their Patients in Managing Serious Mental Illness. Popul Health Manag 2021; 24:S55-S61. [PMID: 34382864 DOI: 10.1089/pop.2021.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Recent national statistics show that an estimated 11.2 million American adults live with serious, chronic forms of mental illness. The burden of mental illness is considerable for these individuals, their families, and communities. Effective medical treatment for serious mental illness (SMI) requires a patient-centered approach that engages patients in shared decision-making and supports the therapeutic alliance. Information regarding medication-taking behavior is essential for making treatment decisions, particularly in the instance of suboptimal therapeutic response. However, the evidence suggests that the probability of nonconformity with prescribed medication is elevated for individuals with SMI and that clinicians often overestimate their patients' adherence to medication-taking behaviors. In patients with SMI, unidentified problems with adherence may lead to unnecessary changes in treatment regimen and increased rates of hospitalization. Although various approaches have been used to assess medication ingestion with greater accuracy, none are without limitation. The growing field of digital medicine has introduced tools that engage patients for clinical purposes, gather and organize clinical data, and help measure care quality. Physician surveys show an appreciable increase in physician adoption of digital clinical tools, and studies suggest that a significant population of patients with SMI own and are comfortable using digital devices and tools. Digital tools designed to help people with SMI have the potential to transform the support and care available to people with mental health disorders, bridging a technology gap in mental health services.
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Affiliation(s)
| | - Laetitia A N'Dri
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
| | - Dexter Waters
- Jefferson College of Population Health, Philadelphia, Pennsylvania, USA
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9
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Gupta P, Voors AA, Patel P, Lane D, Anker SD, Cleland JGF, Dickstein K, Filippatos G, Lang CC, van Veldhuisen DJ, Metra M, Zannad F, Samani NJ, Jones DJL, Squire IB, Ng LL. Non-adherence to heart failure medications predicts clinical outcomes: assessment in a single spot urine sample by liquid chromatography-tandem mass spectrometry (results of a prospective multicentre study). Eur J Heart Fail 2021; 23:1182-1190. [PMID: 33759308 DOI: 10.1002/ejhf.2160] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/13/2021] [Accepted: 03/19/2021] [Indexed: 12/28/2022] Open
Abstract
AIMS Liquid chromatography-mass spectrometry (LC-MS/MS) is an objective new technique to assess non-adherence to medications. We used this method to study the prevalence, predictors and outcomes of non-adherence in patients with heart failure with reduced left ventricular ejection fraction (HFrEF). METHODS AND RESULTS This study included 1296 patients with HFrEF from BIOSTAT-CHF, a study that aimed to optimise guideline-recommended therapies. Angiotensin-converting enzyme inhibitors (ACEi), angiotensin receptor blockers (ARBs), mineralocorticoid receptor antagonists, β-blockers and loop diuretics were measured in a single spot urine sample at 9 months using LC-MS/MS. The relationship between medication non-adherence and the composite endpoint of all-cause death or heart failure hospitalisation, over a median follow-up of 21 months, was evaluated. Non-adherence to at least one prescribed medication was observed in 45.9% of patients. The strongest predictor of non-adherence was non-adherence to any of the other medication classes (P < 0.0005). Regional differences within Europe were observed. On multivariable analyses, non-adherence to ACEi/ARBs and β-blockers was associated with an increased risk of the composite endpoint [hazard ratio (HR) 1.38, 95% confidence interval (CI) 1.09-1.95, P = 0.008 and HR 1.48, 95% CI 1.12-1.96, P = 0.006, respectively). Non-adherence to β-blockers was also associated with an increased risk of death (HR 2.48, 95% CI 1.67-3.68, P < 0.0005). Patients who were non-adherent to loop diuretics were healthier and had a decreased risk of the composite endpoint (HR 0.69, 95% CI 0.51-0.93, P = 0.014). Non-adherence to mineralocorticoid receptor antagonists was not related to any clinical outcome. CONCLUSION Non-adherence to medications, assessed by a single urine test, is common and predicts clinical outcomes in patients with HFrEF.
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Affiliation(s)
- Pankaj Gupta
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Adriaan A Voors
- Department of Cardiology, University of Groningen, Groningen, The Netherlands
| | - Prashanth Patel
- Department of Metabolic Medicine and Chemical Pathology, University Hospitals of Leicester NHS Trust, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Dan Lane
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Stefan D Anker
- Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT); German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - John G F Cleland
- Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Glasgow Royal Infirmary, Glasgow, UK.,National Heart & Lung Institute, Imperial College, London, UK
| | - Kenneth Dickstein
- Medicine, University of Bergen, Stavanger University Hospital, Stavanger, Norway
| | - Gerasimos Filippatos
- Cardiology, University of Cyprus, Heart Failure Unit, National and Kapodistrian University of Athens, School of Medicine, Attikon, University Hospital, Athens, Greece
| | - Chim C Lang
- Division of Molecular & Clinical Medicine, Ninewells Hospital and Medical School, Dundee, UK
| | | | - Marco Metra
- Cardiology, ASST Spedali Civili di Brescia, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Brescia, Italy
| | - Faiez Zannad
- Division of Heart Failure, Hypertension and Preventive Cardiology, Department of Cardiovascular Disease, Academic Hospital (CHU), Clinical Investigation Centre (Inserm-CHU), Nancy, France
| | - Nilesh J Samani
- British Heart Foundation, Department of Cardiovascular Sciences, University of Leicester, NIHR Leicester Biomedical Research Centre, Cardiovascular Unit and University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Don J L Jones
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - Iain B Squire
- University of Leicester, University Hospitals of Leicester, Leicester, UK
| | - Leong L Ng
- Department of Cardiovascular Science, University of Leicester, NIHR Leicester Biomedical Research Centre, Cardiovascular Unit and University Hospitals of Leicester NHS Trust, Leicester, UK
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10
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Zheng T. Sleep disturbance in heart failure: A concept analysis. Nurs Forum 2021; 56:710-716. [PMID: 33665809 DOI: 10.1111/nuf.12566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 11/28/2022]
Abstract
AIM This concept analysis aims to analyze the concept of sleep disturbance (SD) in the context of heart failure (HF) to guide the development of a clearly defined definition. BACKGROUND The term "sleep disturbance" has been used in the literature to describe sleep problems and sleep disorders among individuals with HF. Environmental, physical, psychological, behavioral, and developmental factors complicate the phenomenon of SD in HF. DESIGN Walker and Avant's method was used for this concept analysis. DATA SOURCE Published literature from 2000 to 2020 was identified from electronic health profession-related databases. The current definition and usages of SD were abstracted from empirical work and electronic databases. REVIEW METHODS A focused review of abstracts and full text relating to SD in HF was performed. Studies featuring original data and peer-reviewed articles written in English were included to investigate the multifactorial contextual meaning of the concept. RESULTS SD in HF can be described as a condition in which individuals experience difficulty initiating and maintaining sleep, and difficulty continuing or resuming sleep due to frequent nocturnal arousals due to HF symptoms, sleep-disordered breathing, insomnia, and psychological burdens. CONCLUSIONS To evaluate SD in HF, clinicians must examine the underlying causes to provide the contextual meaning of the concept. A clearly defined and distinguishable concept of SD in HF provides a possibility for accurate measurements of sleep quality, exploring interventions, and evaluating outcomes.
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Affiliation(s)
- Tao Zheng
- Pre-doctoral Fellow, Omics and Symptom Science Training Program, University of Washington School of Nursing, Registered Nurse, University of Washington Medical Center, Seattle, Washington, USA
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11
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Fentie Wendie T, Tarekegn Angamo M. Drug-Therapy Problems and Predictors among Hospitalized Heart-Failure Patients: A Prospective Observational Study. Drug Healthc Patient Saf 2020; 12:281-291. [PMID: 33376412 PMCID: PMC7764776 DOI: 10.2147/dhps.s268923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/14/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Heart-failure patients are at high risk of experiencing drug-therapy problems, owing to polypharmacy, comorbidities, and usually advanced age. Drug-therapy problems can lead to poor clinical outcomes, increased health-care costs and decreased quality of life, and thus strategies for identifying, resolving, and preventing them are urgently needed. Therefore, this study aimed at investigating the incidence and predictors of drug-therapy problems among hospitalized heart-failure patients. METHODS This hospital-based prospective observational study was conducted from February 1 to May 31, 2014 at Jimma University Specialized Hospital. Patients of either sex aged 18 years and above with chronic heart failure and complete medical records were enrolled. Patients with high-output heart failure, <1 day of hospital stay, unwilling to give written informed consent, and unconscious without caregivers were excluded. Data were collected from medication charts, laboratory reports, patients/caregivers, morning multidisciplinary meetings, and ward rounds. Multivariate binary logistic regression analysis was done to identify independent predictors of drug-therapy problems. RESULTS A total of 104 heart-failure patients (mean age 51.20±15.66 years, females 51.9%) were consecutively enrolled, and 95 (91.3%) had experienced at least one drug-therapy problem (total 268, mean 2.82±1.39 encounters per patient). Of these problems, 45.5% were the need for additional drugs, followed by noncompliance (22.0%), inappropriate dosing (9.3%), unnecessary drugs (9.0%), ineffective drugs (8.2%), and adverse drug reactions (6.0%). None of the independent variables was found to be an independent predictor of having at least one drug-therapy problem. However, the number of clinical/pharmacological risk factors (AOR 7.93), female sex (AOR 3.24), and length of hospital stay (AOR 12.98) were predictors of noncompliance. CONCLUSION Patients suffered from a large number of drug-therapy problems. Drugs with survival benefit were underused. Noncompliance and the need for additional drug therapy were the most frequently identified drug-therapy problems. Numbers of clinical/pharmacological risk factors, length of hospital stay, and female sex were identified as predictors for noncompliance.
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Affiliation(s)
| | - Mulugeta Tarekegn Angamo
- Department of Pharmacy, College of Public Health and Medical Sciences, Jimma University, Jimma, Ethiopia
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12
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Spedale V, Luciani M, Attanasio A, Di Mauro S, Alvaro R, Vellone E, Ausili D. Association between sleep quality and self-care in adults with heart failure: A systematic review. Eur J Cardiovasc Nurs 2020; 20:192–201. [PMID: 33909891 DOI: 10.1177/1474515120941368] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 04/14/2020] [Accepted: 06/22/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Sleep disturbance is one of the most common symptoms among heart failure patients. Sleep disturbance reduces quality of life and leads to higher rates of mortality. It may affect the ability of patients to perform adequate self-care. Although some research has evaluated the association between sleep quality and heart failure self-care, a synthesis of the most recent available evidence is lacking. AIMS This systematic review aimed to assess the association between sleep quality and self-care in adults with heart failure. METHODS The Preferred Reporting Items for Systematic Reviews and Meta-Analyses methodology was used. Medline, CINAHL, PsycINFO and SCOPUS were searched. Observational, case-control and cohort studies were considered. The quality of the studies was evaluated with the Joanna Briggs Institute's Critical Appraisal Tools. RESULTS Six articles were included. Association between sleep quality and self-care was reported by three studies. One of these did not find an association between sleep disturbance and heart failure self-care, while the other two studies did. An association between sleep quality and medication adherence was reported by three studies. All three of these studies found associations between these two variables. Studies have measured similar but different constructs. Two studies assessed sleep quality, while four other studies measured excessive daytime sleepiness. Half of the studies examined self-care, while the other half measured medication adherence. CONCLUSIONS Although the evidence should be strengthened, sleep quality seems to affect self-care in heart failure patients. The mechanism underlying the effect of sleep quality on heart failure self-care remains unclear. Future longitudinal interaction analyses could be useful to clarify this mechanism.
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Affiliation(s)
- Valentina Spedale
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Stefania Di Mauro
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Rosaria Alvaro
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome 'Tor Vergata', Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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13
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Lee CS, Faulkner KM, Thompson JH. Identifying subgroups: Part 2: Trajectories of change over time. Eur J Cardiovasc Nurs 2020; 19:444-450. [PMID: 32131616 DOI: 10.1177/1474515120911330] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Methods to identify multiple trajectories of change over time are of great interest in nursing and in related health research. Latent growth mixture modeling is a data-centered analytic strategy that allows us to study questions about distinct trajectories of change in key measures or outcomes of interest. In this article, a worked example of latent growth mixture modeling is presented to help expose researchers to the use and appeal of this analytic strategy.
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14
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Tajeu GS, Kent ST, Huang L, Bress AP, Cuffee Y, Halpern MT, Kronish IM, Krousel-Wood M, Mefford MT, Shimbo D, Muntner P. Antihypertensive Medication Nonpersistence and Low Adherence for Adults <65 Years Initiating Treatment in 2007-2014. Hypertension 2019; 74:35-46. [PMID: 31132956 PMCID: PMC6914333 DOI: 10.1161/hypertensionaha.118.12495] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 04/25/2019] [Indexed: 02/07/2023]
Abstract
Previous evidence suggests modest improvements in antihypertensive medication adherence occurred from 2007 to 2012 among US adults ≥65 years of age. Whether adherence improved over time among adults <65 years of age is unknown. We assessed trends in antihypertensive medication nonpersistence and low adherence among 379 658 commercially insured adults <65 years of age initiating treatment in 2007-2014 using MarketScan claims. Nonpersistence was defined as having no days of medication available to take during the final 90 days of the 365 days following initiation. Among beneficiaries who were persistent to treatment, low adherence was defined by having antihypertensive medication available to take for <80% of the days in the 365 days following initiation (ie, proportion of days covered <80%). In 2007 and 2014, 23.3% and 23.5% of patients were nonpersistent to treatment, respectively, and 42.3% and 40.2% had low adherence, respectively. The relative risks for nonpersistence and low adherence were lower among beneficiaries initiating treatment with an angiotensin-converting enzyme inhibitor (0.95; 95% CI, 0.94-0.97 and 0.97; 95% CI, 0.96-0.98, respectively), angiotensin receptor blocker (0.86; 95% CI, 0.85-0.88 and 0.99; 95% CI, 0.97-1.00, respectively), or multiclass regimen (0.82; 95% CI, 0.80-0.84 and 0.88; 95% CI, 0.86-0.89, respectively), prescribed 90-day versus 30-day prescriptions (0.67; 95% CI, 0.66-0.68 and 0.70; 95% CI, 0.69-0.71, respectively), or who received medications by mail versus at the pharmacy (0.93; 95% CI, 0.90-0.95 and 0.90; 95% CI, 0.88-0.92, respectively). In conclusion, several modifiable factors were associated with lower rates of both antihypertensive medication nonpersistence and low adherence among adults <65 years of age initiating treatment in 2007-2014.
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Affiliation(s)
- Gabriel S. Tajeu
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA
| | | | - Lei Huang
- Department of Epidemiology, University of Alabama at Birmingham
| | - Adam P. Bress
- Department of Population Health Sciences, University of Utah
| | | | - Michael T. Halpern
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA
| | - Ian M. Kronish
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Marie Krousel-Wood
- Department of Medicine, Tulane School of Medicine, Department of Epidemiology, Tulane School of Public Health and Tropical Medicine; Research Division-Center for Applied Health Services Research, Ochsner Health System
| | | | - Daichi Shimbo
- Center for Behavioral Cardiovascular Health, Columbia University Irving Medical Center
| | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham
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15
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De Maria M, Vellone E, Ausili D, Alvaro R, Di Mauro S, Piredda M, De Marinis M, Matarese M. Self-care of patient and caregiver DyAds in multiple chronic conditions: A LongITudinal studY (SODALITY) protocol. J Adv Nurs 2018; 75:461-471. [DOI: 10.1111/jan.13834] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Revised: 07/05/2018] [Accepted: 08/06/2018] [Indexed: 01/22/2023]
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16
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Lee CP, Holmes T, Neri E, Kushida CA. Deception in clinical trials and its impact on recruitment and adherence of study participants. Contemp Clin Trials 2018; 72:146-157. [PMID: 30138717 DOI: 10.1016/j.cct.2018.08.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/27/2018] [Accepted: 08/14/2018] [Indexed: 11/27/2022]
Abstract
Deceptive practices by participants in clinical research are prevalent. It has been shown that as high as 75% of participants withheld information to avoid exclusion from studies. Self-reported adherence has been found to be largely inaccurate. Overcoming deception is a critical issue, since the safety of study participants, the integrity of research data and research resources are at risk. In this review article, we examine deception from the perspective of investigators conducting clinical trials; we describe the types (concealment, fabrication, drug holidays and collusion), prevalence, risks, and predictors of deception, and propose an approach to reduce the impact of deception, especially on adherence, in clinical trials.
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Affiliation(s)
- Chuen Peng Lee
- Department of Respiratory and Critical Care Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, 308433, Singapore.
| | - Tyson Holmes
- Stanford University Human Immune Monitoring Center, Institute for Immunity Transplantation and Infection, Stanford University School of Medicine, Stanford, United States
| | - Eric Neri
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Clete A Kushida
- Stanford Sleep Medicine Center, Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 450 Broadway Street, MC 5704, Pavilion C, 2nd Floor, Redwood City, CA 94063-5704, United States
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17
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Bandoli G, Kuo GM, Sugathan R, Chambers CD, Rolland M, Palmsten K. Longitudinal trajectories of antidepressant use in pregnancy and the postnatal period. Arch Womens Ment Health 2018; 21:411-419. [PMID: 29340802 PMCID: PMC6031455 DOI: 10.1007/s00737-018-0809-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 01/09/2018] [Indexed: 02/07/2023]
Abstract
Studies of antidepressant safety in pregnancy typically do not address complex patterns of use throughout pregnancy. We performed longitudinal trajectory modeling to describe patterns of antidepressant use in the first 32 weeks of pregnancy, and test whether these trajectories are associated with a reduction in birth weight or gestational age at delivery. Our study included 166 pregnant women with deliveries between 2011 and 2015 who were prescribed an antidepressant between 91 days prior to last menstrual period and 32 weeks of gestation. From electronic medical records, we estimated average daily dose and cumulative dose per week for the first 32 weeks of gestation and for the first 13 weeks postnatal. We clustered women with similar utilization patterns using k-means longitudinal modeling and assessed the associations between trajectory group and birth weight and gestational age at delivery. We identified four cumulative dose trajectory groups and three average daily dose trajectory groups in each period. Relative to the lowest trajectory group, the highest trajectory group during pregnancy was associated with reduced birth weight in multivariable analysis (average daily highest trajectory vs. lowest trajectory β - 314.1 g, 95% CI - 613.7, - 15.5) adjusted for depression severity score, maternal age, race, and pregnancy smoking. Trajectory groups were not associated with gestational age at delivery. The highest trajectory group of antidepressant use in pregnancy was associated with a modest reduction in birth weight but not with gestational age at delivery. Longitudinal trajectories allow for a dynamic visualization and quantification of medication use among pregnant women.
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Affiliation(s)
- Gretchen Bandoli
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA.
| | - Grace M Kuo
- Skaggs School of Pharmacy and Pharmaceutical Sciences and Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Renu Sugathan
- Decision Support, University of California San Diego Health and Skaggs School of Pharmacy and Pharmaceutical Sciences and Department of Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Christina D Chambers
- Department of Pediatrics and Family Medicine and Public Health, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Matthieu Rolland
- Inserm, Bordeaux Population Health Research Center, team IDLIC, UMR 1219, University of Bordeaux, F-33000, Bordeaux, France
| | - Kristin Palmsten
- Department of Pediatrics, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA, 92093, USA
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18
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Ohashi M, Kohno T, Kohsaka S, Fukuoka R, Hayashida K, Yuasa S, Sano M, Takatsuki S, Fukuda K. Excessive Daytime Sleepiness Is Associated With Depression Scores, But Not With Sleep-Disordered Breathing in Patients With Cardiovascular Diseases. Circ J 2018; 82:2175-2183. [PMID: 29899174 DOI: 10.1253/circj.cj-17-1395] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Excessive daytime sleepiness (EDS) is a significant public health concern, with sleep-disordered breathing (SDB) being a common cause. However, their precise relationship in patients with cardiovascular disease (CVD) is unclear. Furthermore, whether comorbid psychological disorders could contribute to EDS remains unknown. We aimed to assess the prevalence of EDS and its related factors, including SDB and depression, in patients with CVD.Methods and Results:We analyzed data from 1,571 patients admitted for various CVDs in a single university hospital (median age, 67 [56-76] years; 29.6% women). We assessed EDS using the Japanese version of the Epworth Sleepiness Scale (ESS; median 6.0 [4.0-9.0]). The presence of EDS (ESS >10, n=297 [18.9%]) did not differ between patients with and without SDB, which was screened with nocturnal pulse oximetry. In contrast, the patients with EDS had higher depression scores (Hospital Anxiety and Depression Scale subscore for depression [HADS-D] and Patient Healthcare Questionnaire [PHQ]-9). The depression scores, measured by HADS-D (odds ratio [OR] 1.14; 95% confidence interval [CI], 1.07-1.22) and PHQ-9 (OR, 1.14; 95% CI, 1.07-1.20) were independent determinants of EDS. These relationships among EDS, SDB, and depression were consistent among the subgroups with cardiovascular comorbidities. CONCLUSIONS The presence of EDS is associated with depressive symptoms, but not with SDB, in patients with CVD, suggesting that these patients should be thoroughly assessed for psychological disturbances.
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Affiliation(s)
- Mikiko Ohashi
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Takashi Kohno
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Shun Kohsaka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Ryoma Fukuoka
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Kentaro Hayashida
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Shinsuke Yuasa
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Motoaki Sano
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Seiji Takatsuki
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
| | - Keiichi Fukuda
- Division of Cardiology, Department of Medicine, Keio University School of Medicine
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19
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Palmsten K, Rolland M, Hebert MF, Clowse MEB, Schatz M, Xu R, Chambers CD. Patterns of prednisone use during pregnancy in women with rheumatoid arthritis: Daily and cumulative dose. Pharmacoepidemiol Drug Saf 2018; 27:430-438. [PMID: 29488292 DOI: 10.1002/pds.4410] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 12/08/2017] [Accepted: 01/28/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE To characterize prednisone use in pregnant women with rheumatoid arthritis using individual-level heat-maps and clustering individual trajectories of prednisone dose, and to evaluate the association between prednisone dose trajectory groups and gestational length. METHODS This study included pregnant women with rheumatoid arthritis who enrolled in the MotherToBaby Autoimmune Diseases in Pregnancy Study (2003-2014) before gestational week 20 and reported prednisone use without another oral glucocorticoid during pregnancy (n = 254). Information on medication use and pregnancy outcomes was collected by telephone interview plus by medical record review. Prednisone daily dose and cumulative dose were plotted by gestational day using a heat map for each individual. K-means clustering was used to cluster individual trajectories of prednisone dose into groups. The associations between trajectory group and demographics, disease severity measured by the Health Assessment Questionnaire at enrollment, and gestational length were evaluated. RESULTS Women used prednisone 3 to 292 days during pregnancy, with daily doses ranging from <1 to 60 mg. Total cumulative dose ranged from 8 to 6225 mg. Disease severity, non-biologic disease modifying anti-rheumatic drug use, and gestational length varied significantly by trajectory group. After adjusting for disease severity, non-biologic disease modifying anti-rheumatic drug use, and other covariates, the highest vs lowest daily dose trajectory group was associated with reduced gestational age at delivery (β: -2.3 weeks (95%: -3.4, -1.3)), as was the highest vs lowest cumulative dose trajectory group (β: -2.6 weeks (95%: -3.6, -1.5)). CONCLUSIONS In pregnant women with rheumatoid arthritis, patterns of higher prednisone dose were associated with shorter gestational length compared with lower dose.
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Affiliation(s)
- Kristin Palmsten
- HealthPartners Institute, Minneapolis, MN, USA.,Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA
| | - Matthieu Rolland
- INSERM U1219-Centre Inserm Bordeaux Population Health, Université de Bordeaux, Bordeaux, France
| | - Mary F Hebert
- Departments of Pharmacy and Obstetrics and Gynecology, University of Washington, Seattle, WA, USA
| | - Megan E B Clowse
- Department of Medicine, Duke University Medical Center, Durham, NC, USA
| | - Michael Schatz
- Department of Allergy, Kaiser Permanente Medical Center, San Diego, CA, USA
| | - Ronghui Xu
- Department of Mathematics, University of California, San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
| | - Christina D Chambers
- Department of Pediatrics, University of California, San Diego, La Jolla, CA, USA.,Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, CA, USA
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20
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Salmoirago-Blotcher E, Carey MP. Can Mindfulness Training Improve Medication Adherence? Integrative Review of the Current Evidence and Proposed Conceptual Model. Explore (NY) 2018; 14:59-65. [PMID: 29162428 PMCID: PMC5760398 DOI: 10.1016/j.explore.2017.09.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/15/2017] [Accepted: 09/24/2017] [Indexed: 12/20/2022]
Abstract
Medication adherence is a complex, multi-determined behavior that is often influenced by system- (e.g., cost), drug- (e.g., regimen complexity), and patient-related (e.g., depression) factors. System-level approaches (e.g., making medications more affordable) are critically important but do not address patient-level factors that can undermine adherence. In this paper, we identify patient-level determinants of non-adherence and discuss whether mindfulness-training approaches that target these determinants can help to improve adherence to medical treatment. We highlight two chronic medical conditions (viz., heart failure and HIV) where poor adherence is a significant concern, and examine the evidence regarding the use of mindfulness interventions to improve medication adherence in these two conditions. We also discuss the theoretical underpinnings of mindfulness training with respect to medication adherence, and conclude by suggesting directions for future research.
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Affiliation(s)
- Elena Salmoirago-Blotcher
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02903; The Warren Alpert Medical School of Brown University, Providence, RI; School of Public Health, Brown University, Providence, RI.
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, 164 Summit Avenue, Providence, RI 02903; The Warren Alpert Medical School of Brown University, Providence, RI; School of Public Health, Brown University, Providence, RI
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21
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Mickelson RS, Holden RJ. Medication management strategies used by older adults with heart failure: A systems-based analysis. Eur J Cardiovasc Nurs 2017; 17:418-428. [PMID: 28901787 DOI: 10.1177/1474515117730704] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Older adults with heart failure use strategies to cope with the constraining barriers impeding medication management. Strategies are behavioral adaptations that allow goal achievement despite these constraining conditions. When strategies do not exist, are ineffective or maladaptive, medication performance and health outcomes are at risk. While constraints to medication adherence are described in literature, strategies used by patients to manage medications are less well-described or understood. AIM Guided by cognitive engineering concepts, the aim of this study was to describe and analyze the strategies used by older adults with heart failure to achieve their medication management goals. METHODS This mixed methods study employed an empirical strategies analysis method to elicit medication management strategies used by older adults with heart failure. Observation and interview data collected from 61 older adults with heart failure and 31 caregivers were analyzed using qualitative content analysis to derive categories, patterns and themes within and across cases. RESULTS Data derived thematic sub-categories described planned and ad hoc methods of strategic adaptations. Stable strategies proactively adjusted the medication management process, environment, or the patients themselves. Patients applied situational strategies (planned or ad hoc) to irregular or unexpected situations. Medication non-adherence was a strategy employed when life goals conflicted with medication adherence. The health system was a source of constraints without providing commensurate strategies. CONCLUSIONS Patients strived to control their medication system and achieve goals using adaptive strategies. Future patient self-mangement research can benefit from methods and theories used to study professional work, such as strategies analysis.
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Affiliation(s)
- Robin S Mickelson
- 1 Vanderbilt School of Nursing, Vanderbilt University, USA.,2 Department of Veterans Affairs, Tennessee Valley Healthcare System Nashville, USA
| | - Richard J Holden
- 3 Department of BioHealth Informatics, Indiana University School of Informatics and Computing, USA
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22
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Goldstein CM, Gathright EC, Gunstad J, A Dolansky M, Redle JD, Josephson R, Moore SM, Hughes JW. Depressive symptoms moderate the relationship between medication regimen complexity and objectively measured medication adherence in adults with heart failure. J Behav Med 2017; 40:602-611. [PMID: 28190133 PMCID: PMC5873320 DOI: 10.1007/s10865-017-9829-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 01/13/2017] [Indexed: 11/29/2022]
Abstract
Patients with heart failure (HF) take many medications to manage their HF and comorbidities, and 20-50% experience depression. Depressed individuals with more complex medication regimens may be at greater risk for poor adherence. The aim of this study was to assess depressive symptoms as a moderator of the relationship between medication regimen complexity and medication adherence in an observational study of patients with HF. In hierarchical linear regression with the final sample of 299, the interaction of medication regimen complexity and depressive symptoms predicted medication adherence, p < .05. For individuals with higher levels of depressive symptoms [1 standard deviation (SD) above the mean], more regimen complexity was associated with lower adherence. For individuals with low (1 SD below the mean) or average levels of depressive symptoms, regimen complexity was unrelated to medication adherence. Care management strategies, including pillboxes and caregiver involvement, may be valuable in HF patients with depression.
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Affiliation(s)
- Carly M Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, 196 Richmond Street, Providence, RI, 02903, USA.
- The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI, 02903, USA.
| | - Emily C Gathright
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, 196 Richmond Street, Providence, RI, 02903, USA
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - John Gunstad
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
| | - Mary A Dolansky
- School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Joseph D Redle
- Summa Cardiovascular Institute, Akron City Hospital, Summa Health System, Akron, OH, 44307, USA
| | - Richard Josephson
- School of Medicine, Case Western Reserve University, Cleveland, OH, 44106, USA
- Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, 44106, USA
| | - Shirley M Moore
- School of Nursing, Case Western Reserve University, Cleveland, OH, 44106, USA
| | - Joel W Hughes
- Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA
- Summa Cardiovascular Institute, Akron City Hospital, Summa Health System, Akron, OH, 44307, USA
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23
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Impact of a Multidisciplinary Heart Failure Postdischarge Management Clinic on Medication Adherence. Clin Ther 2017; 39:1200-1209. [PMID: 28545803 DOI: 10.1016/j.clinthera.2017.04.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/17/2017] [Accepted: 04/29/2017] [Indexed: 01/11/2023]
Abstract
PURPOSE Disease management programs have been associated with improved adherence to heart failure (HF) medications. However, there remain limited data on the benefit of a comprehensive multidisciplinary HF postdischarge management (PDM) clinic that promptly follows HF-related hospitalization on evidence-based HF medication adherence. OBJECTIVE The aim of this study was to evaluate the effects of an HF-PDM clinic on adherence to evidence-based HF medication therapy. METHODS In this retrospective cohort study, we identified patients discharged from the Veterans Affairs Greater Los Angeles Healthcare System between 2009 and 2012 with a primary diagnosis of HF. Data from patients who attended the HF-PDM clinic immediately following HF-related hospitalization between 2010 and 2012 were compared with those from historical controls, who did not attend the HF-PDM clinic, from 2009. The main outcome was adherence to evidence-based HF medications during the 90 days after discharge. Adherence was defined as the proportion of days covered at 90 days after discharge (PDC-90) of ≥0.80. The percentages of patients adherent to each medication were compared between the 2 groups using the χ2 test. A logistic regression model adjusted for potential confounding variables was constructed to evaluate the percentages of patients adherent to evidence-based HF medications. FINDINGS A total of 277 patients (144 clinic, 133 control) were included in the study. Both univariate and multivariate analyses showed that the clinic was associated with improved medication adherence to angiotensin-converting enzyme inhibitors, a twice-daily β-blocker, and aldosterone antagonists compared with controls. The most significant increases were in adherence to angiotensin-converting enzyme inhibitors, with mean PDC-90 values of 0.84 (control) versus 0.93 (clinic) (P = 0.008) and 90-day adherence rates of 69% (control) versus 87% (clinic) (P = 0.005). IMPLICATIONS Care in the multidisciplinary HF-PDM clinic was associated with significant increases in 90-day adherence to evidence-based HF medications in patients who were recently discharged after an HF-related hospitalization.
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Ekman I, Wolf A, Vaughan Dickson V, Bosworth HB, Granger BB. Unmet expectations of medications and care providers among patients with heart failure assessed to be poorly adherent: results from the Chronic Heart Failure Intervention to Improve MEdication Adherence (CHIME) study. Eur J Cardiovasc Nurs 2017; 16:646-654. [DOI: 10.1177/1474515117707669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Axel Wolf
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | | | - Hayden B Bosworth
- Center for Health Services Research in Primary Care and Research, VA Medical Center, USA
- Duke University School of Nursing, Durham, NC, USA
- Department of Medicine, Duke University, USA
| | - Bradi B Granger
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Duke University School of Nursing, Durham, NC, USA
- Duke University Health Systems, Durham, NC, USA
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Abstract
BACKGROUND Since the situation-specific theory of heart failure (HF) self-care was published in 2008, we have learned much about how and why patients with HF take care of themselves. This knowledge was used to revise and update the theory. OBJECTIVE The purpose of this article was to describe the revised, updated situation-specific theory of HF self-care. RESULT Three major revisions were made to the existing theory: (1) a new theoretical concept reflecting the process of symptom perception was added; (2) each self-care process now involves both autonomous and consultative elements; and (3) a closer link between the self-care processes and the naturalistic decision-making process is described. In the revised theory, HF self-care is defined as a naturalistic decision-making process with person, problem, and environmental factors that influence the everyday decisions made by patients and the self-care actions taken. The first self-care process, maintenance, captures those behaviors typically referred to as treatment adherence. The second self-care process, symptom perception, involves body listening, monitoring signs, as well as recognition, interpretation, and labeling of symptoms. The third self-care process, management, is the response to symptoms when they occur. A total of 5 assumptions and 8 testable propositions are specified in this revised theory. CONCLUSION Prior research illustrates that all 3 self-care processes (ie, maintenance, symptom perception, and management) are integral to self-care. Further research is greatly needed to identify how best to help patients become experts in HF self-care.
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Goldstein CM, Gathright EC, Garcia S. Relationship between depression and medication adherence in cardiovascular disease: the perfect challenge for the integrated care team. Patient Prefer Adherence 2017; 11:547-559. [PMID: 28352161 PMCID: PMC5359120 DOI: 10.2147/ppa.s127277] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Many individuals with cardiovascular disease (CVD) experience depression that is associated with poor health outcomes, which may be because of medication nonadherence. Several factors influence medication adherence and likely influence the relationship between depression and medication adherence in CVD patients. This comprehensive study reviews the existing literature on depression and medication adherence in CVD patients, addresses the methods of and problems with measuring medication adherence, and explains why the integrated care team is uniquely situated to improve the outcomes in depressed CVD patients. This paper also explores how the team can collaboratively target depressive symptoms and medication-taking behavior in routine clinical care. Finally, it suggests the limitations to the integrated care approach, identifies targets for future research, and discusses the implications for CVD patients and their families.
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Affiliation(s)
- Carly M Goldstein
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI
- Correspondence: Carly M Goldstein, Department of Psychiatry and Human Behavior, Weight Control and Diabetes Research Center, Warren Alpert Medical School of Brown University, The Miriam Hospital, 196 Richmond Street, Providence, RI 02903, USA, Tel +1 401 793 8960, Fax +1 401 793 8944, Email
| | - Emily C Gathright
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University
- Department of Psychological Sciences, Kent State University, Kent, OH
| | - Sarah Garcia
- Neuropsychology Section, Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
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Iyngkaran P, Toukhsati SR, Harris M, Connors C, Kangaharan N, Ilton M, Nagel T, Moser DK, Battersby M. Self Managing Heart Failure in Remote Australia - Translating Concepts into Clinical Practice. Curr Cardiol Rev 2016; 12:270-284. [PMID: 27397492 PMCID: PMC5304248 DOI: 10.2174/1573403x12666160703183001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 12/28/2015] [Accepted: 01/11/2016] [Indexed: 11/23/2022] Open
Abstract
Congestive heart failure (CHF) is an ambulatory health care condition characterized by episodes of decompensation and is usually without cure. It is a leading cause for morbidity and mortality and the lead cause for hospital admissions in older patients in the developed world. The long-term requirement for medical care and pharmaceuticals contributes to significant health care costs. CHF management follows a hierarchy from physician prescription to allied health, predominately nurse-led, delivery of care. Health services are easier to access in urban compared to rural settings. The differentials for more specialized services could be even greater. Remote Australia is thus faced with unique challenges in delivering CHF best practice. Chronic disease self-management programs (CDSMP) were designed to increase patient participation in their health and alleviate stress on health systems. There have been CDSMP successes with some diseases, although challenges still exist for CHF. These challenges are amplified in remote Australia due to geographic and demographic factors, increased burden of disease, and higher incidence of comorbidities. In this review we explore CDSMP for CHF and the challenges for our region.
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Dolansky MA, Hawkins MAW, Schaefer JT, Sattar A, Gunstad J, Redle JD, Josephson R, Moore SM, Hughes JW. Association Between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients With Heart Failure. Circ Heart Fail 2016; 9:e002475. [PMID: 27895069 PMCID: PMC5131517 DOI: 10.1161/circheartfailure.116.002475] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 10/17/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND Subclinical cognitive impairment is prevalent in heart failure (HF); however, its role in important clinical outcomes, such as HF treatment adherence, is unclear. Given the complex polypharmacy in HF treatment, cognitive deficits may be important in predicting medication management. Thus, the objective of the current study was to examine the impact of cognitive function on medication adherence among community-dwelling patients with HF using objective assessments. METHODS AND RESULTS A prospective observational cohort design of 309 community-dwelling patients with HF (59.7% male, 68.7±9.7 years) and no history of dementia or neurological disease. Cognition was assessed using a neuropsychological battery at baseline. Medication adherence was objectively measured for 21 days using an electronic pillbox. Regression analyses tested whether attention, executive function, or memory predicted 21-day medication adherence. In unadjusted analyses, lower scores on all 3 cognitive domains predicted poorer medication adherence (β=0.52-85; P=0.001-0.009). After adjusting for demographic, clinical, and psychosocial variables, memory continued to predict medication adherence (β=0.51; P=0.008), whereas executive function (β=0.24; P=0.075) and attention were no longer a predictor (β=0.34; P=0.131). CONCLUSIONS Poorer cognitive function, especially in regard to memory, predicted reduced medication adherence among patients with HF and no history of dementia. This effect remained after adjustment for factors known to predict adherence, such as depressed mood, social support, and disease severity level. Future studies should examine the link from cognitive impairment and medication nonadherence to clinical outcomes (eg, hospitalization and mortality). CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01461629.
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Affiliation(s)
- Mary A Dolansky
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.)
| | - Misty A W Hawkins
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.)
| | - Julie T Schaefer
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.)
| | - Abdus Sattar
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.)
| | - John Gunstad
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.)
| | - Joseph D Redle
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.)
| | - Richard Josephson
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.)
| | - Shirley M Moore
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.)
| | - Joel W Hughes
- From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.).
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Librero J, Sanfélix-Gimeno G, Peiró S. Medication Adherence Patterns after Hospitalization for Coronary Heart Disease. A Population-Based Study Using Electronic Records and Group-Based Trajectory Models. PLoS One 2016; 11:e0161381. [PMID: 27551748 PMCID: PMC4995009 DOI: 10.1371/journal.pone.0161381] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 08/04/2016] [Indexed: 11/23/2022] Open
Abstract
Objective To identify adherence patterns over time and their predictors for evidence-based medications used after hospitalization for coronary heart disease (CHD). Patients and Methods We built a population-based retrospective cohort of all patients discharged after hospitalization for CHD from public hospitals in the Valencia region (Spain) during 2008 (n = 7462). From this initial cohort, we created 4 subcohorts with at least one prescription (filled or not) from each therapeutic group (antiplatelet, beta-blockers, ACEI/ARB, statins) within the first 3 months after discharge. Monthly adherence was defined as having ≥24 days covered out of 30, leading to a repeated binary outcome measure. We assessed the membership to trajectory groups of adherence using group-based trajectory models. We also analyzed predictors of the different adherence patterns using multinomial logistic regression. Results We identified a maximum of 5 different adherence patterns: 1) Nearly-always adherent patients; 2) An early gap in adherence with a later recovery; 3) Brief gaps in medication use or occasional users; 4) A slow decline in adherence; and 5) A fast decline. These patterns represented variable proportions of patients, the descending trajectories being more frequent for the beta-blocker and ACEI/ARB cohorts (16% and 17%, respectively) than the antiplatelet and statin cohorts (10% and 8%, respectively). Predictors of poor or intermediate adherence patterns were having a main diagnosis of unstable angina or other forms of CHD vs. AMI in the index hospitalization, being born outside Spain, requiring copayment or being older. Conclusion Distinct adherence patterns over time and their predictors were identified. This may be a useful approach for targeting improvement interventions in patients with poor adherence patterns.
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Affiliation(s)
- Julián Librero
- Health Services Research Unit, Center for Public Health Research (CSISP-FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - Gabriel Sanfélix-Gimeno
- Health Services Research Unit, Center for Public Health Research (CSISP-FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
- * E-mail:
| | - Salvador Peiró
- Health Services Research Unit, Center for Public Health Research (CSISP-FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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Dolansky MA, Schaefer JT, Hawkins MAW, Gunstad J, Basuray A, Redle JD, Fang JC, Josephson RA, Moore SM, Hughes JW. The association between cognitive function and objective adherence to dietary sodium guidelines in patients with heart failure. Patient Prefer Adherence 2016; 10:233-41. [PMID: 27042017 PMCID: PMC4780397 DOI: 10.2147/ppa.s95528] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although cognitive impairment is common in heart failure (HF) patients, its effects on sodium adherence recommendations are unknown. PURPOSE Our aim is to examine if cognitive function is associated with patient sodium adherence. METHODS Sodium collection/excretion and cognitive function were assessed for 339 HF patients over a 5-8-week period. Neuropsychological testing was performed at baseline (Visit 1), whereas two 24-hour urine samples were collected within 7 weeks postbaseline. The ability to collect two 24-hour urine samples and the estimation of sodium excretion levels from these samples were used to estimate sodium adherence recommendations. RESULTS Nearly half (47%) of the study participants (n=159) were unable to give two valid 24-hour urine samples. Participants who were unable to adhere to two valid 24-hour urine samples had significantly poorer attention and global cognition tests (P<0.044), with a trend for poorer executive function (P=0.064). Among those with valid samples, urine sodium level was not associated with global cognitive function, attention, executive function, or memory after adjusting for covariates. Female sex was associated with lower sodium excretion (all P<0.01); individuals with knowledge of sodium guidelines had less intake of sodium, resulting in excretion of less sodium (all P≤0.03). Conversely, higher socioeconomic status (SES) and body mass index (BMI) were associated with greater sodium (all P≤0.02 and P≤0.01). CONCLUSION Adherence to urine sodium collection was poor, especially among those with poorer cognitive function. Sodium consumption exceeded recommended amounts and was unrelated to cognitive function. Interventions for improving sodium adherence should focus on at-risk groups (high SES and BMI) and at improving knowledge of recommended salt intake.
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Affiliation(s)
- Mary A Dolansky
- School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | | | - Misty AW Hawkins
- Department of Psychology, Oklahoma State University, Stillwater, OK, USA
| | - John Gunstad
- Department of Psychology, Kent State University, Kent, OH, USA
| | - Anup Basuray
- Ohio Health Heart and Vascular Physicians, Columbus, OH, USA
| | - Joseph D Redle
- Department of Cardiology, Summa Health System, Akron City Hospital, OH, USA
| | - James C Fang
- Department of Internal Medicine, Division of Cardiology, University Hospital, Salt Lake City, UT, USA
| | - Richard A Josephson
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
- Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Shirley M Moore
- School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Joel W Hughes
- Department of Psychology, Kent State University, Kent, OH, USA
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Sanfélix-Gimeno G, Rodríguez-Bernal CL, Hurtado I, Baixáuli-Pérez C, Librero J, Peiró S. Adherence to oral anticoagulants in patients with atrial fibrillation-a population-based retrospective cohort study linking health information systems in the Valencia region, Spain: a study protocol. BMJ Open 2015; 5:e007613. [PMID: 26482766 PMCID: PMC4611755 DOI: 10.1136/bmjopen-2015-007613] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Adherence to oral anticoagulation (OAC) treatment, vitamin K antagonists or new oral anticoagulants, is an essential element for effectiveness. Information on adherence to OAC in atrial fibrillation (AF) and the impact of adherence on clinical outcomes using real-world data barely exists. We aim to describe the patterns of adherence to OAC over time in patients with AF, estimate the associated factors and their impact on clinical events, and assess the same issues with conventional measures of primary and secondary adherence-proportion of days covered (PDC) and persistence-in routine clinical practice. METHODS AND ANALYSIS This is a population-based retrospective cohort study including all patients with AF treated with OAC from 2010 to date in Valencia, Spain; data will be obtained from diverse electronic records of the Valencia Health Agency. PRIMARY OUTCOME MEASURE adherence trajectories. SECONDARY OUTCOMES (1) primary non-adherence; (2) secondary adherence: (a) PDC, (b) persistence. Clinical outcomes: hospitalisation for haemorrhagic or thromboembolic events and death during follow-up. ANALYSIS (1) description of baseline characteristics, adherence patterns (trajectory models or latent class growth analysis models) and conventional adherence measures; (2) logistic or Cox multivariate regression models, to assess the associations between adherence measures and the covariates, and logistic multinomial regression models, to identify characteristics associated with each trajectory; (3) Cox proportional hazard models, to assess the relationship between adherence and clinical outcomes, with propensity score adjustment applied to further control for potential confounders; (4) to estimate the importance of different healthcare levels in the variations of adherence, logistic or Cox multilevel regression models. ETHICS AND DISSEMINATION This study has been approved by the corresponding Clinical Research Ethics Committee. We plan to disseminate the project's findings through peer-reviewed publications and presentations at relevant health conferences. Policy reports will also be prepared in order to promote the translation of our findings into policy and clinical practice.
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Affiliation(s)
- G Sanfélix-Gimeno
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - C L Rodríguez-Bernal
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - I Hurtado
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - C Baixáuli-Pérez
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - J Librero
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
| | - S Peiró
- Health Services Research Unit, Fundación para el Fomento de la Investigación Sanitaria y Biomédica de la Comunidad Valenciana (FISABIO), Valencia, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Valencia, Spain
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Background and design of the profiling biobehavioral responses to mechanical support in advanced heart failure study. J Cardiovasc Nurs 2015; 29:405-15. [PMID: 23839571 DOI: 10.1097/jcn.0b013e318299fa09] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Unexplained heterogeneity in response to ventricular assist device (VAD) implantation for the management of advanced heart failure impedes our ability to predict favorable outcomes, provide adequate patient and family education, and personalize monitoring and symptom management strategies. The purpose of this article was to describe the background and the design of a study entitled "Profiling Biobehavioral Responses to Mechanical Support in Advanced Heart Failure" (PREMISE). STUDY DESIGN AND METHODS PREMISE is a prospective cohort study designed to (1) identify common and distinct trajectories of change in physical and psychological symptom burden; (2) characterize common trajectories of change in serum biomarkers of myocardial stress, systemic inflammation, and endothelial dysfunction; and (3) quantify associations between symptoms and biomarkers of pathogenesis in adults undergoing VAD implantation. Latent growth mixture modeling, including parallel process and cross-classification modeling, will be used to address the study aims and will entail identifying trajectories, quantifying associations between trajectories and both clinical and quality-of-life outcomes, and identifying predictors of favorable symptom and biomarker responses to VAD implantation. CONCLUSIONS Research findings from the PREMISE study will be used to enhance shared patient and provider decision making and to shape a much-needed new breed of interventions and clinical management strategies that are tailored to differential symptom and pathogenic responses to VAD implantation.
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Patterns of Glaucoma Medication Adherence over Four Years of Follow-Up. Ophthalmology 2015; 122:2010-21. [PMID: 26319441 DOI: 10.1016/j.ophtha.2015.06.039] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 06/04/2015] [Accepted: 06/20/2015] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To assess longer-term patterns of glaucoma medication adherence and identify whether patterns established during the first year of medication use persist during 3 subsequent years of follow-up. DESIGN Retrospective, longitudinal cohort analysis. PARTICIPANTS Beneficiaries aged ≥40 years who were enrolled in a United States (US)-managed care plan for ≥7 years between 2001 and 2012 and newly diagnosed and treated for open-angle glaucoma. METHODS For each enrollee, we quantified medication adherence using the medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses. MAIN OUTCOME MEASURES Patterns of glaucoma medication adherence. RESULTS Of the 1234 eligible beneficiaries, GBTM identified 5 distinct glaucoma medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits (P < 0.05 for all comparisons). Those with a higher initial copayment cost had lower adherence rates (β = -0.06/dollar, P = 0.03). CONCLUSIONS For most patients who were newly prescribed glaucoma medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.
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Clark AP, McDougall G, Riegel B, Joiner-Rogers G, Innerarity S, Meraviglia M, Delville C, Davila A. Health Status and Self-care Outcomes After an Education-Support Intervention for People With Chronic Heart Failure. J Cardiovasc Nurs 2015; 30:S3-13. [PMID: 24978157 PMCID: PMC4276559 DOI: 10.1097/jcn.0000000000000169] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The rising cost of hospitalizations for heart failure (HF) care mandates intervention models to address education for self-care success. The effectiveness of memory enhancement strategies to improve self-care and learning needs further examination. OBJECTIVE The objective of this study was to examine the effects of an education-support intervention delivered in the home setting, using strategies to improve health status and self-care in adults/older adults with class I to III HF. Our secondary purpose was to explore participants' subjective perceptions of the intervention. METHODS This study used a randomized, 2-group design. Fifty people were enrolled for 9 months and tested at 4 time points-baseline; after a 3-month education-support intervention; at 6 months, after 3 months of telephone/e-mail support; and 9 months, after a 3-month period of no contact. Advanced practice registered nurses delivered the intervention. Memory enhancement methods were built into the teaching materials and delivery of the intervention. We measured the intervention's effectiveness on health status outcomes (functional status, self-efficacy, quality of life, emotional state/depressive symptoms, and metamemory) and self-care outcomes (knowledge/knowledge retention, self-care ability). Subjects evaluated the usefulness of the intervention at the end of the study. RESULTS The mean age of the sample was 62.4 years, with a slight majority of female participants. Participants were well educated and had other concomitant diseases, including diabetes (48%) and an unexpected degree of obesity. The intervention group showed significant improvements in functional status, self-efficacy, and quality of life (Kansas City Cardiomyopathy Questionnaire); metamemory Change and Capacity subscales (Metamemory in Adulthood Questionnaire); self-care knowledge (HF Knowledge Test); and self-care (Self-care in Heart Failure Index). Participants in both groups improved in depressive scores (Geriatric Depression Scale). CONCLUSIONS An in-home intervention delivered by advanced practice registered nurses was successful in several health status and self-care outcomes, including functional status, self-efficacy, quality of life, metamemory, self-care status, and HF knowledge.
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Affiliation(s)
- Angela P Clark
- Angela P. Clark, PhD, RN, ACNS-BC, FAAN, FAHA Associate Professor of Nursing Emerita, The University of Texas at Austin. Graham McDougall, PhD, RN, FAAN, FGSA Professor of Nursing, The University of Alabama at Tuscaloosa. Barbara Riegel, PhD, RN, FAHA, FAAN Professor of Nursing, School of Nursing, The University of Pennsylvania, Philadelphia. Glenda Joiner-Rogers, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Sheri Innerarity, PhD, RN, ACNS-BC, FNP Associate Professor of Clinical Nursing, The University of Texas at Austin. Martha Meraviglia, PhD, RN, ACNS-BC Associate Professor of Clinical Nursing, The University of Texas at Austin. Carol Delville, PhD, RN, ACNS-BC Assistant Professor of Clinical Nursing, The University of Texas at Austin. Ashley Davila, MSN, ACNS-BC Clinical Nurse Specialist, Texas Diabetes and Endocrinology, Austin
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Dickson VV, Knafl GJ, Riegel B. Predictors of medication nonadherence differ among black and white patients with heart failure. Res Nurs Health 2015; 38:289-300. [PMID: 25962474 DOI: 10.1002/nur.21663] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2015] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF.
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Affiliation(s)
- Victoria Vaughan Dickson
- Assistant Professor College of Nursing, New York University, 433 First Avenue, #742, New York, NY, 10010
| | - George J Knafl
- Professor School of Nursing, University of North Carolina, Chapel Hill, NC
| | - Barbara Riegel
- Professor and Edith Clemmer Steinbright Chair of Gerontology School of Nursing, University of Pennsylvania, Philadelphia, PA
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HIV protective efficacy and correlates of tenofovir blood concentrations in a clinical trial of PrEP for HIV prevention. J Acquir Immune Defic Syndr 2014; 66:340-8. [PMID: 24784763 PMCID: PMC4059553 DOI: 10.1097/qai.0000000000000172] [Citation(s) in RCA: 258] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Supplemental Digital Content is Available in the Text. Background: Antiretroviral pre-exposure prophylaxis (PrEP) is a novel HIV prevention strategy for which adherence is a known determinant of efficacy. Blood concentrations of PrEP medications are one objective marker of adherence. Methods: In a placebo-controlled PrEP efficacy trial of tenofovir disoproxil fumarate (TDF) and TDF with emtricitabine (FTC/TDF) among 4747 African women and men with an HIV-infected partner, we measured plasma tenofovir concentrations from participants in the active PrEP arms: 29 HIV seroconverters (cases) and 196 randomly selected controls who remained uninfected. Results: Among controls, 71% of visits had tenofovir concentrations >40 ng/mL, consistent with steady-state daily dosing, compared with 21% of cases at the visit HIV was first detected. Pill count data indicated that 96% of controls and 66% of cases had >80% adherence for these same visits. The estimated protective effect of PrEP against HIV, based on concentrations >40 ng/mL, was 88% (95% confidence interval: 60 to 96, P < 0.001) for individuals receiving TDF and 91% (95% confidence interval: 47 to 98, P = 0.008) for individuals receiving FTC/TDF. Controls had consistent patterns of PrEP concentrations during follow-up; among the 81% with concentrations >40 ng/mL at month 1, 75% maintained this concentration at month 12. Only 5 of 29 seroconverters seemed to be consistently adherent to PrEP. Tenofovir concentrations >40 ng/mL were associated with older age and shorter time on study; concentrations ≤40 ng/mL occurred more commonly when participants reported no sex with their HIV-infected partner. Conclusions: Plasma concentrations of tenofovir consistent with daily dosing were highly predictive of protection from HIV acquisition. Most of those who took PrEP seemed to have high and consistent adherence.
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Abstract
BACKGROUND The prevention of fluid retention is important to reduce hospitalizations in patients with heart failure (HF). Following a low-sodium diet helps to reduce fluid retention. OBJECTIVE The primary objective of this study was to use growth mixture modeling to identify distinct classes of sodium adherence-characterized by shared growth trajectories of objectively measured dietary sodium. The secondary objective was to identify patient-level determinants of the nonadherent trajectory. METHODS This was a secondary analysis of data collected from a prospective longitudinal study of 279 community-dwelling adults with previously or currently symptomatic HF. Growth mixture modeling was used to identify distinct trajectories of change in 24-hour urinary sodium excretion measured at 3 time points over 6 months. Logistic modeling was used to predict membership in observed trajectories. RESULTS The sample was predominantly male (64%), had a mean age of 62 years, was functionally compromised (59% New York Heart Association class III), and had nonischemic HF etiology. Two distinct trajectories of sodium intake were identified and labeled adherent (66%) and nonadherent (34%) to low-sodium diet recommendations. Three predictors of the nonadherent trajectory were identified, confirming our previous mixed-effect analysis. Compared with being normal weight (body mass index <25 kg/m2), being overweight and obese was associated with a 4-fold incremental increase in the likelihood of being in the nonadherent trajectory (odds ratio [OR], 4.63; 95% confidence interval [CI], 1.66-12.91; P < .002). Being younger than 65 years (OR, 4.66; 95% CI, 1.04-20.81; P = .044) or having diabetes (OR, 4.15; 95% CI, 1.29-13.40; P = .016) were both associated with more than 4 times the odds of being in the nonadherent urine sodium trajectory compared with being older than 65 years or not having diabetes, respectively. CONCLUSIONS Two distinct trajectories of sodium intake were identified in patients with HF. The nonadherent trajectory was characterized by an elevated pattern of dietary sodium intake shown by others to be associated with adverse outcomes in HF. Predictors of the nonadherent trajectory included higher body mass index, younger age, and diabetes.
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Abstract
BACKGROUND Patients' adherence with posttransplant immunosuppression is known to affect renal transplant outcomes. METHODS Prospectively, individual medication adherence patterns in 195 kidney transplant recipients were quantified with electronic medication monitors. Monitored drugs were mycophenolate mofetil, sirolimus, or azathioprine. Monitoring began at hospital discharge and continued an average of 15±8 months. Patient follow-up for clinical outcomes averaged 8±3 years. Each month's adherence percentage was calculated as the sum of daily adherence percents, divided by the number of evaluable days. RESULTS During the first 3 months after transplantation, patients (n=44) with declining medication adherence, defined as dropping by 7% or higher (equal to missing 2 days) between months 1 and 2, later experienced lower mean medication adherence for months 6 to 12, 73% versus 92% respectively (P<0.0001). Compared to patients with stable adherence, they also had more frequent (P=0.034) and earlier (P=0.065) acute rejection episodes. This was additionally associated with more frequent (P=0.017) and earlier (P=0.046) death-censored graft loss.In addition, daily medication adherence, expressed as the percentage of doses taken, decreased as the number of prescribed daily doses increased. During the first 3 months after transplantation, adherence with four doses per day averaged 84%, compared to 91% for patients on twice-daily dosing (P=0.024) and 93.5% for patients on once-daily dosing (P=0.008). CONCLUSIONS Early declining medication nonadherence is associated with adverse clinical outcomes. This pattern is detectable during the first 2 months after transplantation. Early detection of nonadherence provides opportunities to target interventions toward patients at the highest risk for adverse behaviors and events.
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Masterson Creber R, Topaz M, Lennie TA, Lee CS, Puzantian H, Riegel B. Identifying predictors of high sodium excretion in patients with heart failure: a mixed effect analysis of longitudinal data. Eur J Cardiovasc Nurs 2014; 13:549-58. [PMID: 24366985 PMCID: PMC4386996 DOI: 10.1177/1474515113517606] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND A low-sodium diet is a core component of heart failure self-care but patients have difficulty following the diet. AIM The aim of this study was to identify predictors of higher than recommended sodium excretion among patients with heart failure. METHODS The World Health Organization Five Dimensions of Adherence model was used to guide analysis of existing data collected from a prospective, longitudinal study of 280 community-dwelling adults with previously or currently symptomatic heart failure. Sodium excretion was measured objectively using 24-hour urine sodium measured at three time points over six months. A mixed effect logistic model identified predictors of higher than recommended sodium excretion. RESULTS The adjusted odds of higher sodium excretion were 2.90, (95% confidence interval (CI): 1.15-4.25, p<0.001) for patients who were obese; 2.80 (95% CI: 1.33-5.89, p=0.007) for patients with diabetes; and 2.22 (95% CI: 1.09-4.53, p=0.028) for patients who were cognitively intact. CONCLUSION Three factors were associated with excess sodium excretion and two factors, obesity and diabetes, are modifiable by changing dietary food patterns.
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Affiliation(s)
| | - Maxim Topaz
- School of Nursing, University of Pennsylvania USA
| | | | | | - Houry Puzantian
- Department of Biobehavioral Health Science, University of Illinois at Chicago, USA
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Lee CS, Mudd JO, Hiatt SO, Gelow JM, Chien C, Riegel B. Trajectories of heart failure self-care management and changes in quality of life. Eur J Cardiovasc Nurs 2014; 14:486-94. [PMID: 24982435 DOI: 10.1177/1474515114541730] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 06/09/2014] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Heart failure patients vary considerably in their self-care management behaviors (i.e. recognizing and responding to symptoms). The goal of this study was to identify unique patterns of change in heart failure self-care management and quantify associations between self-care management and quality of life (HRQOL) over time. METHODS A prospective cohort study among adults with symptomatic heart failure was designed to measure changes in self-care management (Self-care of Heart Failure Index) and HRQOL (Kansas City Cardiomyopathy Questionnaire) over six months. Growth mixture modeling was used to identify unique trajectories of change in self-care management. RESULTS The mean age (n=146) was 57 years, 70% were male, and 41% had class II heart failure. Two trajectories of self-care management were identified (entropy = 0.88). The larger trajectory (73.3%) was characterized by a significant decline in self-care management over time and no change in HRQOL. The smaller trajectory (26.7%) was characterized by marked improvements in self-care management and HRQOL. Changes in heart failure self-care management occurred in the absence of change in routine self-care maintenance behaviors, functional classification, and physical and psychological symptoms. Patients with greater physical symptoms at enrollment (odds ratio (OR) =1.04, p=0.037), larger left ventricles (OR=1.50, p=0.044), and ischemic heart failure (OR=3.84, p=0.014) were more likely to have the declining trajectory of self-care management. Higher levels of depression at enrollment were associated with reduced odds of having a decline in self-care management over time (OR=0.85, p<0.001). CONCLUSIONS There are unique and clinically-relevant trajectories of change in heart failure self-care management that are associated with differences in HRQOL.
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Affiliation(s)
- Christopher S Lee
- Oregon Health & Science University School of Nursing and Knight Cardiovascular Institute, Portland, USA
| | - James O Mudd
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, USA
| | - Shirin O Hiatt
- Oregon Health & Science University School of Nursing, Portland, USA
| | - Jill M Gelow
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, USA
| | - Christopher Chien
- Knight Cardiovascular Institute, Oregon Health & Science University, Portland, USA
| | - Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, USA
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Abstract
BACKGROUND Medication nonadherence is a major cause of hospitalization in patients with heart failure (HF), which contributes enormously to health care costs. We previously found, using the World Health Organization adherence dimensions, that condition and patient level factors predicted nonadherence in HF. In this study, we assessed a wider variety of condition and patient factors and interactions to improve our ability to identify those at risk for hospitalization. MATERIALS AND METHODS Medication adherence was measured electronically over the course of 6 months, using the Medication Event Monitoring System (MEMS). A total of 242 HF patients completed the study, and usable MEMS data were available for 218 (90.1%). Participants were primarily white (68.3%), male (64.2%), and retired (44.5%). Education ranged from 8-29 years (mean, 14.0 years; standard deviation, 2.9 years). Ages ranged from 30-89 years (mean, 62.8 years; standard deviation, 11.6 years). Analyses used adaptive methods based on heuristic searches controlled by cross-validation scores. First, individual patient adherence patterns over time were used to categorize patients in poor versus better adherence types. Then, risk factors for poor adherence were identified. Finally, an effective model for predicting poor adherence was identified based on identified risk factors and possible pairwise interactions between them. RESULTS A total of 63 (28.9%) patients had poor adherence. Three interaction risk factors for poor adherence were identified: a higher number of comorbid conditions with a higher total number of daily medicines, older age with poorer global sleep quality, and fewer months since diagnosis of HF with poorer global sleep quality. Patients had between zero and three risk factors. The odds for poor adherence increased by 2.6 times with a unit increase in the number of risk factors (odds ratio, 2.62; 95% confidence interval, 1.78-3.86; P<0.001). CONCLUSION Newly diagnosed, older HF patients with comorbid conditions, polypharmacy, and poor sleep are at risk for poor medication adherence. Interventions addressing these specific barriers are needed.
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Affiliation(s)
- George J Knafl
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA, USA
- Leonard Davis Institute, University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Barbara Riegel, School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA, Tel +1 215 898 9927, Fax +1 240 282 7707, Email
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Jaarsma T, Deaton C, Fitzsimmons D, Fridlund B, Hardig BM, Mahrer-Imhof R, Moons P, Noureddine S, O’Donnell S, Pedersen SS, Stewart S, Strömberg A, Thompson DR, Tokem Y, Kjellström B. Research in cardiovascular care: A position statement of the Council on Cardiovascular Nursing and Allied Professionals of the European Society of Cardiology. Eur J Cardiovasc Nurs 2013; 13:9-21. [DOI: 10.1177/1474515113509761] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Tiny Jaarsma
- Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Christi Deaton
- School of Nursing, Midwifery & Social Work, Central Manchester University Hospitals NHS Foundation Trust, UK
| | | | - Bengt Fridlund
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Bjarne M Hardig
- Physio-Control Sweden/Jolife AB, Sweden; Department of Cardiology, Lund University, Sweden
| | - Romy Mahrer-Imhof
- Institute of Nursing, Zurich University of Applied Sciences, Switzerland
| | - Philip Moons
- Department of Public Health and Primary Care, University of Leuven, Belgium; The Heart Centre, Copenhagen University Hospital, Denmark
| | - Samar Noureddine
- Hariri School of Nursing, American University of Beirut, Lebanon
| | | | - Susanne S Pedersen
- Department of Medical and Clinical Psychology, Tilburg University, The Netherlands; Thorax Center, Erasmus Medical Center, The Netherlands; Institute of Psychology, University of Southern Denmark, Denmark; Department of Cardiology, Odense University Hospital, Denmark
| | - Simon Stewart
- National Health and Medical Research Council (NHMRC) Centre of Research Excellence to Reduce Inequality in Heart Disease & Preventative Health, Baker IDI Heart and Diabetes Institute, Australia
| | - Anna Strömberg
- Department of Medicine and Health Sciences, Linköping University, Sweden; Department of Cardiology, County Council of Östergötland, Sweden
| | - David R Thompson
- Cardiovascular Research Centre, Australian Catholic University, Australia
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Psotka MA, Teerlink JR. Strategies to Prevent Postdischarge Adverse Events Among Hospitalized Patients with Heart Failure. Heart Fail Clin 2013; 9:303-20, vi. [DOI: 10.1016/j.hfc.2013.04.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Jaarsma T, Strömberg A, Ben Gal T, Cameron J, Driscoll A, Duengen HD, Inkrot S, Huang TY, Huyen NN, Kato N, Köberich S, Lupón J, Moser DK, Pulignano G, Rabelo ER, Suwanno J, Thompson DR, Vellone E, Alvaro R, Yu D, Riegel B. Comparison of self-care behaviors of heart failure patients in 15 countries worldwide. PATIENT EDUCATION AND COUNSELING 2013; 92:114-120. [PMID: 23579040 DOI: 10.1016/j.pec.2013.02.017] [Citation(s) in RCA: 176] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 01/09/2013] [Accepted: 02/24/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE Clinicians worldwide seek to educate and support heart failure patients to engage in self-care. We aimed to describe self-care behaviors of patients from 15 countries across three continents. METHODS Data on self-care were pooled from 5964 heart failure patients from the United States, Europe, Australasia and South America. Data on self-care were collected with the Self-care of Heart Failure Index or the European Heart Failure Self-care Behavior Scale. RESULTS In all the samples, most patients reported taking their medications as prescribed but exercise and weight monitoring were low. In 14 of the 22 samples, more than 50% of the patients reported low exercise levels. In 16 samples, less than half of the patients weighed themselves regularly, with large differences among the countries. Self-care with regard to receiving an annual flu shot and following a low sodium diet varied most across the countries. CONCLUSION Self-care behaviors are sub-optimal in heart failure patients and need to be improved worldwide. PRACTICE IMPLICATIONS Interventions that focus on specific self-care behaviors may be more effective than general educational programs. Changes in some health care systems and national policies are needed to support patients with heart failure to increase their self-care behavior.
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Affiliation(s)
- Tiny Jaarsma
- Department of Social and Welfare Studies, Linköping University, Linköping, Sweden.
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Tang HYJ, Sayers SL, Weissinger G, Riegel B. The role of depression in medication adherence among heart failure patients. Clin Nurs Res 2013; 23:231-44. [PMID: 23548500 DOI: 10.1177/1054773813481801] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The purpose of the study was to explore the association between depression and medication adherence in heart failure (HF) patients. Studies have shown that people with depression are likely to be nonadherent to their prescribed medication treatment. But other studies suggest that nonadherence may be overestimated by people with depression. A total of 244 adults with Stage C HF completed the study. Self-reported medication adherence was obtained using the Basel Assessment of Adherence Scale (BAAS); objective data on medication adherence were collected using the electronic Medication Event Monitoring System (MEMS). Depression was measured via self-report with the Patient Health Questionnaire (PHQ-9). There was a significant difference between depressed and nondepressed participants in self-reported medication nonadherence (p = .008), but not in objectively measured medication nonadherence (p = .72). The depressed sample was 2.3 times more likely to self-report poor medication adherence than those who were nondepressed (p = .006).
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Riegel B, Knafl GJ. Electronically monitored medication adherence predicts hospitalization in heart failure patients. Patient Prefer Adherence 2013; 8:1-13. [PMID: 24353407 PMCID: PMC3862652 DOI: 10.2147/ppa.s54520] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Hospitalization contributes enormously to health care costs associated with heart failure. Many investigators have attempted to predict hospitalization in these patients. None of these models has been highly effective in prediction, suggesting that important risk factors remain unidentified. PURPOSE To assess prospectively collected medication adherence, objectively measured by the Medication Event Monitoring System, as a predictor of hospitalization in heart failure patients. MATERIALS AND METHODS We used recently developed adaptive modeling methods to describe patterns of medication adherence in a sample of heart failure patients, and tested the hypothesis that poor medication adherence as determined by adaptive methods was a significant predictor of hospitalization within 6 months. RESULTS Medication adherence was the best predictor of hospitalization. Besides two dimensions of poor adherence (adherence pattern type and low percentage of prescribed doses taken), four other single factors predicted hospitalization: low hemoglobin, depressed ejection fraction, New York Heart Association class IV, and 12 or more medications taken daily. Seven interactions increased the predictive capability of the model: 1) pattern of poor adherence type and lower score on the Letter-Number Sequencing test, a measure of short-term memory; 2) higher number of comorbid conditions and higher number of daily medications; 3) higher blood urea nitrogen and lower percentage of prescribed doses taken; 4) lower hemoglobin and much worse perceived health compared to last year; 5) older age and lower score on the Telephone Interview of Cognitive Status; 6) higher body mass index and lower hemoglobin; and 7) lower ejection fraction and higher fatigue. Patients with none of these seven interactions had a hospitalization rate of 9.7%. For those with five of these interaction risk factors, 100% were hospitalized. The C-index (the area under the receiver-operating characteristics [ROC] curve) for the model based on the seven interactions was 0.83, indicating excellent discrimination. CONCLUSION Medication adherence adds important new information to the list of variables previously shown to predict hospitalization in adults with heart failure.
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Affiliation(s)
- Barbara Riegel
- University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- University of Pennsylvania Leonard Davis Institute, Philadelphia, PA, USA
- Correspondence: Barbara Riegel, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA, Tel +1 215 898 9927, Fax +1 240 282 7707, Email
| | - George J Knafl
- University of North Carolina School of Nursing, Chapel Hill, NC, USA
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