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Comparative Study
. 2013 Jan-Feb;19(1):16-24.
doi: 10.1111/j.1751-7133.2012.00308.x. Epub 2012 Sep 9.

Patient-reported selective adherence to heart failure self-care recommendations: a prospective cohort study: the Atlanta Cardiomyopathy Consortium

Catherine N Marti  1 , Vasiliki V Georgiopoulou, Grigorios Giamouzis, Robert T Cole, Anjan Deka, W H W Tang, Sandra B Dunbar, Andrew L Smith, Andreas P Kalogeropoulos, Javed Butler
Affiliations
Comparative Study

Patient-reported selective adherence to heart failure self-care recommendations: a prospective cohort study: the Atlanta Cardiomyopathy Consortium

Catherine N Marti et al. Congest Heart Fail. 2013 Jan-Feb.

Abstract

Simultaneous adherence with multiple self-care instructions among heart failure (HF) patients is not well described. Patient-reported adherence to 8 recommendations related to exercise, alcohol, medications, smoking, diet, weight, and symptoms was assessed among 308 HF patients using the Medical Outcomes Study Specific Adherence Scale questionnaire (0="never" to 5="always," maximum score=40). A baseline cumulative score of ≥32/40 (average ≥80%) defined good adherence. Clinical events (death/transplantation/ventricular assist device), resource utilization, functional capacity (6-minute walk distance), and health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were compared among patients with and without good adherence. The mean follow-up was 2.0±1.0 years, and adherence ranged from 26.3% (exercise) to 89.9% (medications). A cumulative score indicating good adherence was reported by 35.7%, whereas good adherence with every behavior was reported by 9.1% of patients. Good adherence was associated with fewer hospitalizations (all-cause 87.8 vs 107.6; P=.018; HF 29.6 vs 43.8; P=.007) and hospitalized days (all-cause 422 vs 465; P=.015; HF 228 vs 282; P<.001) per 100-person-years and better health status (KCCQ overall score 70.1±24.6 vs 63.8±22.8; P=.011). Adherence was not associated with clinical events or functional capacity. Patient-reported adherence with HF self-care recommendations is alarmingly low and selective. Good adherence was associated with lower resource utilization and better health status.

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Conflict of interest statement

Conflict of Interest: None

Figures

Figure 1
Figure 1
The Atlanta Cardiomyopathy Consortium: Study Design
Figure 2
Figure 2
Medical Outcomes Study Specific Adherence Scale
Figure 3
Figure 3. Adherence by Individual Self-care Recommendation
Patient self-reported score 0 indicates “none of the time”, 1 “a little of the time”, 2 “some of the time”, 3 “a good bit of the time”, 4 “most of the time”, and 5 represents “all of the time.”
Figure 4
Figure 4. Health Status and Self Care
Comparison of Kansas City Cardiomyopathy Questionnaire scores between adherent and non-adherent patients; * P<0.05 using the Mann-Whitney statistic
See this image and copyright information in PMC

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