Medication Adherence, Depressive Symptoms, and Cardiac Event–Free Survival in Patients With Heart Failure

Abstract

Background Medication nonadherence and depressive symptoms predict hospitalization and death in patients with heart failure (HF). Depressed patients have lower medication adherence than non-depressed patients. However, the predictive power of the combination of medication adherence and depressive symptoms for hospitalization and death has not been investigated in patients with HF. Objective To explore the combined influence of medication adherence and depressive symptoms for prediction of cardiac event-free survival in patients with HF. Method We monitored medication adherence in 216 HF patients who completed the Patient Health Questionnaire-9 (PHQ-9) at baseline. Medication adherence was measured objectively using Medication Event Monitoring System (MEMS). Patients were followed for up to 3 1/2 years to collect data on cardiac event(s). Survival analyses were used to compare cardiac event-free survival between/among groups. Results The risk of experiencing a cardiac event for patients with medication nonadherence and depressive symptoms was 5 times higher compared to those who were medication adherent without depressive symptoms. The risk of experiencing a cardiac event for patients with only one risk factor was 1.2–1.3 times that of those with neither risk factor. Conclusion Medication nonadherence and depressive symptoms had a negative synergistic effect on cardiac event-free survival in patients with HF.

Psychological Determinants of Heart Failure Self-Care

“…Inconclusive evidence was found for anxiety as a determinant of HF self-care among the five prospective studies (25,27,28,34,55)) (Appendix Table). One study (34) considered of high quality indicated that increased anxiety at baseline was associated with an increase in HF self-care over time.…”

“…Regarding the remaining prospective studies, depression was associated with medication nonadherence (25,26,30), but no longer after taking other explaining factors such as age, disease severity, and medication burden into account (26,30).…”

Palliative Care and Cardiovascular Disease and Stroke: A Policy Statement From the American Heart Association/American Stroke Association

“…31 Depressed patients with HF have more medication nonadherence, worse health status, and higher healthcare use. 32,33 In the pediatric HF population, feeding problems are common, affecting neurodevelopment and contributing to parental stress. 34 Parents of children who die of advanced heart disease describe that as many as half of children suffer "a great deal" or "somewhat" in the last month of life and that 70% of these children experience a HRQOL in that last month that is "poor" or "fair."…”

Influence of Psychoemotional Disorders on the Effectiveness of Education and Active Outpatient Control in Heart Failure Patients

“…Однако исследования показывают, что эффективность таких программ может широко варь-ировать в зависимости от их структуры и содержания, а также в зависимости от базовых характеристик вклю-ченных пациентов. Наличие депрессии у пациентов с СН может негативно влиять на прогноз, количество госпита-лизаций и способность пациентов к самопомощи и само-контролю [5][6][7]. Вероятно, наличие депрессии у паци-ента с СН может оказывать негативное воздействие и на его восприимчивость к различным воздействиям в рамках ПУБ и снижать их эффективность.…”