title: Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure.
abstract: OBJECTIVE
  Prognosis is worse in unmarried patients compared with married patients with heart failure (HF). The reasons for differences in outcomes are unclear, but variations in medication adherence may play a role, because medication adherence is essential to achieving better outcomes. The study objective was to determine whether medication adherence mediated the relationship between marital status and cardiac event-free survival in patients with HF.
  
  
  METHODS
  Demographic, clinical, and psychosocial data were collected by questionnaires and medical record review for 136 patients with HF (aged 61 ± 11 years, 70% were male, 60% were in New York Heart Association class III/IV). Medication adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Cardiac event-free survival data were obtained by patient/family interview, hospital database, and death certificate review. A series of regression and Cox survival analyses were performed to determine whether medication adherence mediated the relationship between marital status and event-free survival.
  
  
  RESULTS
  Cardiac event-free survival was worse in unmarried patients than in married patients. Unmarried patients were more likely to be nonadherent and 2 times more likely to experience an event than married patients (P = .017). Marital status was not a significant predictor of event-free survival after entering medication adherence in the model, demonstrating a mediation effect of adherence on the relationship of marital status to survival.
  
  
  CONCLUSIONS
  Medication adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase medication adherence that take into account subgroups, such as unmarried patients, who are at higher risk for nonadherence.
authors: University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina 27599-7460, USA. jiarongw@email.unc.edu
authors: Jia-Rong
authors: JR
authors: Wu
authors: Terry A
authors: TA
authors: Lennie
authors: Misook L
authors: ML
authors: Chung
authors: Susan K
authors: SK
authors: Frazier
authors: Rebecca L
authors: RL
authors: Dekker
authors: Martha J
authors: MJ
authors: Biddle
authors: Debra K
authors: DK
authors: Moser
mesh_terms: D002317:Cardiovascular Agents / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D008297:Male; D017533:Marital Status; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011594:Psychometrics / Q000379:methods; D011795:Surveys and Questionnaires
chemical_list: D002317:Cardiovascular Agents