Patterns of adherence to diuretics, dietary sodium and fluid intake recommendations in adults with heart failure

Abstract

Background: Three behaviors advocated to minimize fluid-related hospitalizations in patients with heart failure (HF) are restricted sodium and fluid intake and consistent oral diuretic use. Adherence to behaviors intended to decrease risk of hospitalization is believed to vary over time, but surprisingly little research has addressed patterns of adherence in HF patients.

Objective: To describe patterns over time of 3 recommended self-care behaviors (i.e., diet, fluid intake, and diuretic dosing) in adults with HF and to determine how time and behavior influenced adherence rates.

Methods: We enrolled 24 adults hospitalized for a HF exacerbation and discharged on a loop diuretic into a descriptive, longitudinal pilot study. Over 3-months, diuretic use was measured using electronic event monitoring, and participants were telephoned regularly to assess sodium and fluid intake. Data were summarized for each 2-week intervals.

Results: The overall adherence rates were 42.4% for low sodium diet, 96.4% for fluid restriction, and 84.7% for the diuretic regimen. Early after hospital discharge, medication adherence was the highest, and dietary adherence was the lowest, but adherence to diet and diuretic use decreased significantly over time.

Conclusion: Although participants were just discharged from the hospital after an acute exacerbation of HF, all three behavioral patterns decreased markedly over the 3-month follow-up period.

Keywords: Heart failure; Medication adherence; Self-care; Signs and symptoms; Treatment adherence.

Figure 1.

Trends of Adherence Rates. Dotted line shows trends.

Figure 2.

Two Multiple Linear Regression Models on Treatment Adherence Rates. In the first model without interaction terms between time and each behavior, the effect of Week on adherence rate was the same across behaviors (3 parallel regression lines). In other words, the differences in adherence rates among the 3 behaviors were constant over time (from week 2 to 12). The coefficient of Week (slope, −1.14) represented the amount by which adherence rate (%) changed for each week; y intercepts showed the expected adherence rates at week 0.