Interest in healthy lifestyle and adherence to medications: Impact on mortality among elderly cardiovascular patients in the DEBATE Study.
OBJECTIVE
We examined how a patient-centered consultation can help the physician to evaluate older patients' adherence to medical care and a healthy lifestyle. We hypothesised that an accurate estimate of adherence should be shown in their prognosis.


METHODS
Cardiovascular patients (>74 years) in an intervention study (the DEBATE Study) were divided according to physician's clinical impression: (1) "Active adherents" (N=53): those having a healthy lifestyle and adherent to medications. (2) "Passive adherents" (N=65): those not showing any particular interest in a healthy lifestyle but adherent to medications. (3) "Interested scepticals" (N=66): those showing an interest in a healthy lifestyle but feeling sceptical about medications. (4) "Passive non-adherents" (N=15): those having a sedentary lifestyle and non-adherence to medical treatments. The combined endpoint was permanent institutionalisation or death during the average 4.5-year follow-up.


RESULTS
Mortality during the 4.5-year follow-up ranged among groups 1-4: 15, 19, 26, and 53% (p=0.01), and the proportions permanently institutionalised 0, 2, 6, and 20% (p=0.003). Multivariate analyses with age, gender, Charlson comorbidity index, dependence in ADL activities and with group 1 as the reference (1.0) showed that both group 3 (HR 2.73, 95% CI 1.11-6.52) and group 4 (HR 6.24, 95% CI 1.88-20.67) were at significantly increased risk for institutionalisation or death.


CONCLUSIONS
In a patient-centered consultation adherence can be accurately evaluated, and such an evaluation is of significant value in the prognosis of older cardiovascular patients.


CONCLUSIONS
A patient's expression of attitudes towards medications and healthy lifestyle may be elicited in a patient-centered consultation. This patient-centered approach may help in modifying care to support appropriate, tailored treatments for individual patients.
Pitkala
Kaisu H
KH
University of Helsinki, Department of Primary Care and General Practice, Helsinki, Finland. kaisu.pitkala@helsinki.fi
Strandberg
Timo E
TE
Tilvis
Reijo S
RS
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000401:mortality / Q000628:therapy*; D005260:Female; D005387:Finland; D006801:Humans; D008019:Life Style; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance; D018802:Patient-Centered Care; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic