Medication Adherence Mediates the Relationship between Ethnicity and Event-Free Survival in Patients with Heart Failure

2008 ◽  
Vol 14 (6) ◽  
pp. S95-S96
Author(s):  
Jia-Rong Wu ◽  
Debra K. Moser ◽  
Terry A. Lennie ◽  
Misook L. Chung ◽  
Marla J. De Jong
2010 ◽  
Vol 16 (2) ◽  
pp. 142-149 ◽  
Author(s):  
Jia-Rong Wu ◽  
Terry A. Lennie ◽  
Marla J. De Jong ◽  
Susan K. Frazier ◽  
Seongkum Heo ◽  
...  

Heart & Lung ◽  
2012 ◽  
Vol 41 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Jia-Rong Wu ◽  
Terry A. Lennie ◽  
Misook L. Chung ◽  
Susan K. Frazier ◽  
Rebecca L. Dekker ◽  
...  

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Marla J De Jong ◽  
Debra K Moser ◽  
Misook L Chung ◽  
Jia-Rong Wu

Anxiety has been linked to adverse outcomes for patients with cardiac disease but the mechanism for this relationship is unknown. Nonadherence to prescribed medications is common in heart disease, particularly heart failure (HF), and may mediate the relationship between anxiety and outcomes. To determine if nonadherence to prescribed medications mediates any relationship between anxiety and clinical outcomes in patients with HF. Patients (N=147; age 61±11 yrs, 44% female, 59% NYHA class III/IV) with chronic HF were followed 389±324 days for clinical events (composite of death, emergency department visit, or hospitalization). Patients completed the anxiety subscale of the Brief Symptom Inventory at baseline. Objective evidence of medication adherence was measured with the Medication Event Monitoring System. Survival and regression analyses were used to test whether medication nonadherence mediated any association between anxiety and outcomes. Patients with highest anxiety had shorter event-free survival than patients with lower anxiety (Fig. ). After adjusting for age, gender, and NYHA class in Cox regression, high anxiety predicted (OR 2.4; p=.001) clinical events. Anxiety predicted medication doses taken (p=.01) and days correct doses taken (p=.008). Medication doses taken (p=.01) and days dose taken (p=.008) also predicted clinical outcomes. Medication nonadherence mediated the relationship between high anxiety and worse outcomes. This is the first study to show that medication nonadherence links anxiety and clinical outcomes. Interventions that decrease anxiety may improve both medication adherence and outcomes.


2013 ◽  
Vol 19 (5) ◽  
pp. 317-324 ◽  
Author(s):  
Jia-Rong Wu ◽  
Terry A. Lennie ◽  
Rebecca L. Dekker ◽  
Martha J. Biddle ◽  
Debra K. Moser

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Jia-Rong Wu ◽  
Debra K Moser ◽  
Misook Chung ◽  
Terry A Lennie

Background: Medication nonadherence is presumed to be related to poor clinical outcomes including emergency department (ED) visits, rehospitalization and mortality, yet this relationship has not been tested using objective adherence measures in patients with heart failure (HF). Therefore, it is unknown which objective indicators of medication adherence predict clinical outcomes and how self-reported adherence measures compare to objective measures in predicting clinical outcomes. Objective: The purpose of this study was to determine which indicators of medication adherence are predictors of event-free survival in patients with HF. Methods: A total of 134 patients with HF (70% male, 61 ±12, 61% NYHA III/IV) were enrolled in this 6-month longitudinal predictive study. Medication adherence was measured using an objective measure, the Medication Event Monitoring System (MEMS) and self-reported adherence from the Medical Outcomes Studies Specific Adherence Scale. Four indicators of adherence were assessed by the MEMS: dose-count, percentage of prescribed doses taken; dose-days, percentage of days the correct number of doses taken; dose-time, percentage of doses taken on schedule; and therapeutic coverage, percentage of time therapeutic drug action maintained. Events (ED visits, rehospitalization, and mortality) were obtained by patient/family interview and hospital databases. Results: In Cox regression, three of the four MEMS indicators, dose-count, dose-day, and therapeutic coverage, predicted time to first event before and after controlling age, gender, ejection fraction, NYHA, angiotensin-converting enzyme inhibitor use, and beta-blocker use ( p = .004, .008, and < .001, respectively). Self-report medication adherence did not predict outcomes ( p = .402). Conclusions: The percentage of prescribed doses taken, percentage of days the correct number of doses taken, and overall therapeutic coverage predicted event-free survival. Neither the percentage of doses taken on schedule nor self-reported adherence predicted outcomes. Healthcare providers should assess specific behaviors related to medication taking rather than a global patient self-assessment of patient adherence.


2013 ◽  
Vol 32 (6) ◽  
pp. 637-646 ◽  
Author(s):  
Jia-Rong Wu ◽  
Susan K. Frazier ◽  
Mary Kay Rayens ◽  
Terry A. Lennie ◽  
Misook L. Chung ◽  
...  

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