title: Patient-reported selective adherence to heart failure self-care recommendations: a prospective cohort study: the Atlanta Cardiomyopathy Consortium.
abstract: Simultaneous adherence with multiple self-care instructions among heart failure (HF) patients is not well described. Patient-reported adherence to 8 recommendations related to exercise, alcohol, medications, smoking, diet, weight, and symptoms was assessed among 308 HF patients using the Medical Outcomes Study Specific Adherence Scale questionnaire (0="never" to 5="always," maximum score=40). A baseline cumulative score of ≥32/40 (average ≥80%) defined good adherence. Clinical events (death/transplantation/ventricular assist device), resource utilization, functional capacity (6-minute walk distance), and health status (Kansas City Cardiomyopathy Questionnaire [KCCQ]) were compared among patients with and without good adherence. The mean follow-up was 2.0±1.0 years, and adherence ranged from 26.3% (exercise) to 89.9% (medications). A cumulative score indicating good adherence was reported by 35.7%, whereas good adherence with every behavior was reported by 9.1% of patients. Good adherence was associated with fewer hospitalizations (all-cause 87.8 vs 107.6; P=.018; HF 29.6 vs 43.8; P=.007) and hospitalized days (all-cause 422 vs 465; P=.015; HF 228 vs 282; P<.001) per 100-person-years and better health status (KCCQ overall score 70.1±24.6 vs 63.8±22.8; P=.011). Adherence was not associated with clinical events or functional capacity. Patient-reported adherence with HF self-care recommendations is alarmingly low and selective. Good adherence was associated with lower resource utilization and better health status.
authors.affiliation: Division of Cardiology, Emory University, Atlanta, GA 30322, USA.
authors.forename: Catherine N
authors.initials: CN
authors.lastname: Marti
authors.forename: Vasiliki V
authors.initials: VV
authors.lastname: Georgiopoulou
authors.forename: Grigorios
authors.initials: G
authors.lastname: Giamouzis
authors.forename: Robert T
authors.initials: RT
authors.lastname: Cole
authors.forename: Anjan
authors.initials: A
authors.lastname: Deka
authors.forename: W H W
authors.initials: WH
authors.lastname: Tang
authors.forename: Sandra B
authors.initials: SB
authors.lastname: Dunbar
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Smith
authors.forename: Andreas P
authors.initials: AP
authors.lastname: Kalogeropoulos
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
mesh_terms: D005260:Female; D005500:Follow-Up Studies; D005845:Georgia; D006304:Health Status; D006333:Heart Failure / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011788:Quality of Life; D012648:Self Care / Q000379:methods*; D011795:Surveys and Questionnaires