Factors precipitating congestive heart failure--role of patient non-compliance.
OBJECTIVE
This study was aimed to identify systematically the precipitating factors causing decompensation of heart failure and subsequent hospitalisation. We specially assessed the role of patient non-compliance with therapy as an important precipitating factor for heart failure, since it has not been systematically studied previously in an Indian setting where rheumatic heart disease is common.


METHODS
In this cross-sectional analytical study, 125 cases of congestive heart failure hospitalized in Government Medical College, Nagpur, were studied. All the patients were thoroughly evaluated and investigated to identify the precipitating factors for heart failure. A patient was categorized as being non-compliant with therapy if he/she was consuming less than 80% prescribed drugs (assessed by pill count) or was non-compliant with dietary advice (assessed by an interviewer-administered questionnaire).


RESULTS
Rheumatic heart disease was the commonest underlying heart disease (52.8%) followed by ischemic and/or hypertensive heart disease (27.2%). The most common precipitating factor was patient non-compliance with diet or drug therapy (49.6%) followed by arrhythmias (16.8%), uncontrolled hypertension (14.4%), infective endocarditis (13.6%), anemia (14.4%) and infections (11.2%).


CONCLUSIONS
The results emphasize the importance of patient non-compliance with prescribed therapy as a leading precipitating factor for congestive heart failure in an Indian setting, which can be prevented by appropriate cost-effective strategies aimed to improve patient compliance.
Joshi
P P
PP
Clinical Epidemiology Unit, Govt Medical College, Nagpur.
Mohanan
C J
CJ
Sengupta
S P
SP
Salkar
R G
RG
D015984:Causality; D003430:Cross-Sectional Studies; D005069:Evaluation Studies as Topic; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D007194:India / Q000453:epidemiology; D008297:Male; D010349:Patient Compliance; D010353:Patient Education as Topic; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016312:Treatment Refusal / Q000706:statistics & numerical data*