title: Association between Spirituality and Adherence to Management in Outpatients with Heart Failure.
abstract: BACKGROUND
  Spirituality may influence how patients cope with their illness.
  
  
  OBJECTIVE
  We assessed whether spirituality may influence adherence to management of outpatients with heart failure.
  
  
  METHODS
  Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence.
  
  
  RESULTS
  One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments.
  
  
  CONCLUSIONS
  Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient's care may lead to an improvement in adherence patterns in the complex heart failure management.
authors.affiliation: Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Juglans Souto
authors.initials: JS
authors.lastname: Alvarez
authors.affiliation: Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Livia Adams
authors.initials: LA
authors.lastname: Goldraich
authors.affiliation: Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Alice Hoefel
authors.initials: AH
authors.lastname: Nunes
authors.affiliation: Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Mônica Cristina Brugalli
authors.initials: MC
authors.lastname: Zandavalli
authors.affiliation: Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Rafaela Brugalli
authors.initials: RB
authors.lastname: Zandavalli
authors.affiliation: Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
authors.forename: Karlyse Claudino
authors.initials: KC
authors.lastname: Belli
authors.affiliation: Division of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Neusa Sica da
authors.initials: NS
authors.lastname: Rocha
authors.affiliation: Division of Psychiatry, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Marcelo Pio de Almeida
authors.initials: MP
authors.lastname: Fleck
authors.affiliation: Division of Cardiology, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Nadine
authors.initials: N
authors.lastname: Clausell
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology; D005260:Female; D006333:Heart Failure / Q000523:psychology* / Q000628:therapy; D006801:Humans; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D010045:Outpatients; D010349:Patient Compliance / Q000523:psychology; D011594:Psychometrics / Q000379:methods; D011788:Quality of Life / Q000523:psychology; D012067:Religion; D012649:Self Concept; D029181:Spirituality