Health-Related Quality of Life Is a Mediator of the Relationship Between Medication Adherence and Cardiac Event-Free Survival in Patients with Heart Failure
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Study Design
This was a prospective, observational study. To increase sample size, we used data from 2 prospective, longitudinal studies in this secondary data analysis.18,25 Both studies explored the relationships among psychosocial and behavioral factors and outcomes (eg, HRQOL and event-free survival).26,33 The inclusion and exclusion criteria and the measures of medication adherence, HRQOL, and cardiac events were the same in both studies.26,33 In this study, we explored the relationship among
Patient Characteristics
A total of 218 patients with HF and complete MEMS data were included in the analysis (Table 1). There were no differences in sample characteristics between the 232 patients in the original studies and the 218 patients in this study. The mean age and standard deviation of the patients was 60 ± 12 years. The majority of patients were taking a beta-blocker (91%) and angiotensin-converting enzyme inhibitor (71%). There were 82 patients in study 1 and 136 patients in study 2. The percentage of
Discussion
In this study, we explored the relationships among medication adherence, HRQOL, and cardiac event-free survival in patients with HF. We found that medication adherence and HRQOL both independently were associated with cardiac event-free survival in patients with HF. We previously reported that medication nonadherence was associated with higher risk of cardiac events.26,36 Patients with nonadherence to prescribed medications had 2.2 times the risk of experiencing a cardiac event than those with
Limitations
First, although medication adherence measured by the MEMS is a gold standard, there is no guarantee that patients take their medication each time they open the medication cap. However, the MEMS is the most commonly used objective measure of adherence and is considered to be the reference measure of medication adherence in the research settings.55
Second, medication adherence was measured in different duration of 2 studies. The difference in duration may have a potential influence on the recorded
Conclusions
Better medication adherence is associated with better HRQOL. HRQOL mediated the relationship between medication adherence and cardiac event-free survival. Both medication adherence and HRQOL independently and in combination were associated with cardiac event-free survival in this sample. Medication adherence and patient HRQOL are important on patient health outcomes. Regular assessment and interventions to improve medication adherence and HRQOL are needed for better clinical outcomes.
Disclosures
The authors have nothing to disclose.
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Cited by (0)
Supported by funding from the Philips Medical-American Association of Critical Care Nurses Outcomes Grant, American Heart Association Great River Affiliate Post-doctoral Fellowship to Jia-Rong Wu and by funding from the National Institute of Nursing Research (NINR): K23NR014489 (J. Wu, PI), University of Kentucky Clinical and Translational Science Center (M01RR02602). The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies.