Compliance therapy in patients with chronic heart failure: a review

2011 ◽  
Vol 6 (1) ◽  
pp. 240
Author(s):  
Maria Fernanda de Oliveira Carvalho ◽  
João Carlos Alchieri
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Treatment Adherence ◽  
Psychological Assessment ◽  
Patient Adherence ◽  
Adherence To Treatment ◽  
Disease Characteristics ◽  
Compliance Behavior ◽  
Insuficiencia Cardiaca

ABSTRACTObjective: to check which instruments have been used in psychological assessment of treatment adherence, the indicators have shown the results from these instruments for research and evaluation of this aspect, as well as reflect on the applicability of the practice of the psychologist. Method: this integrative review is performed in the Portal Periodicos Capes, using the keywords adherence, instruments and chronic heart failure and correlates in English. Results: poor adherence to treatment may be associated with several factors, from socioeconomic, psychological disorders and cognitive impairment until the disease characteristics and complexity of treatment, the relationship between health professional and patient, however, is one of the factors contributing to treatment adherence. Conclusion: some authors have sought to present methods to assess adherence to treatment, including psychological tests and inventories, but there are a limited number of investigations in this direction. It is known that the compliance behavior involves many different factors, which requires thorough investigation by means of psychological assessment, to identify those which favor or hinder the appropriate follow-up treatment, and promote greater understanding of both the healthcare staff as to patient, allowing for intervention strategies. Descriptors: heart failure; patient adherence; treatment.RESUMOObjetivo: verificar quais instrumentos psicológicos vêm sendo utilizados na avaliação da aderência terapêutica, apresentar os indicadores evidenciados nos resultados provenientes de tais instrumentos para investigação e avaliação deste aspecto, bem como refletir acerca da aplicabilidade destes na prática de atuação do psicólogo. Método: trata-se de revisão integrativa realizada no portal Periódicos Capes, utilizando-se os descritores aderência, instrumentos e insuficiência cardíaca crônica, bem como os correlatos em língua inglesa. Resultados: a baixa adesão ao tratamento pode estar associada a diversos fatores, desde problemas socioeconômicos, distúrbios psicológicos, e prejuizos cognitivos, até as características da doença e a complexidade do tratamento; o relacionamento entre o profissional de saude e o paciente, em contrapartida, é um dos fatores que contribui à adesão ao tratamento. Conclusão: alguns autores vêm buscando apresentar métodos que avaliem a adesão ao tratamento incluindo testes e inventários psicológicos, porém há um número limitado de investigação nesse sentido. Sabe-se que o comportamento aderente envolve muitos e diferentes fatores, o que requer investigação aprofundada por meio da avaliação psicológica, no sentido de identificar quais destes favorecem ou dificultam o seguimento adequado do tratamento, e promover maior conhecimento tanto à equipe de saude quanto ao paciente, possibilitando estratégias de intervenção. Descritores: insuficiência cardíaca; adesão do paciente; tratamento.RESUMENObjetivo: comprobar que instrumentos psicológicos han sido utilizados en la evaluación de la adherencia al tratamiento, presente los indicadores que se evidencia en los resultados de estos instrumentos para la investigación y la evaluación de este aspecto, así como reflexionar sobre la aplicabilidad destas en la práctica del psicólogo. Método: se trata de un revisión integradora celebrada en el Portal Periodicos Capes, utilizando los descriptores la adhesión, los instrumentos y la insuficiencia cardiaca crónica y se correlaciona en inglés. Resultados: la mala adherencia al tratamiento puede estar asociado con varios factores, desde socioeconómica, trastornos psicológicos y deterioro cognitivo hasta la características de la enfermedad y la complejidad del tratamento; la relación entre el profesional de la salud y el paciente, sin embargo, es uno de los factores que contribuyen a la adherencia al tratamiento. Conclusión: algunos autores han tratado de presentar los métodos para evaluar la adherencia al tratamiento, incluyendo las pruebas psicológicas y los inventarios, pero hay un número limitado de investigaciones en esta dirección. Se sabe que el comportamiento de cumplimiento implica muchos factores diferentes, lo que requiere una investigación a fondo por medio de la evaluación psicológica, para identificar los que favorecen o dificultan la comprensión de un seguimiento adecuado del tratamiento, y promover una mayor conocimiento tanto del personal médico en cuanto a paciente, teniendo en cuenta las estrategias de intervención. Descriptores: insuficiencia cardíaca; adhesión del paciente; el tratamiento.

Diary of self-monitoring of the patient as a way to increase adherence to the treatment of patients with chronic heart failure

2019 ◽  
Vol 23 (2) ◽  
pp. 21-26
Author(s):  
Elena V. Frolova ◽  
Alena I. Ogorelysheva ◽  
Ekaterina S. Spasenova ◽  
Tamara R. Khalilova
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Self Control ◽  
Control Group ◽  
Adherence To Treatment ◽  
Self Monitoring ◽  
Phone Calls ◽  
Sequential Sample ◽  
Adherence To Therapy

Chronic heart failure (CHF) is the most frequent and severe complication of cardiovascular disease (CVD). One of the most important aspects of management of patients with CHF remains to ensure adherence to treatment. The purpose of the study was to assess the effectiveness of therapy of patients with CHF with the use of a diary of self-control as a way of enhancing adherence to therapy. Materials and methods. A continuous sequential sample was used to select 40 patients with diagnosed Heart Failure II-IV FC (NYHA), who were then randomized into two groups: the follow-up group (n = 20) and the control group (n = 20). The study duration was 8 weeks. Patients of the observation group received materials on self-control (“Diary of a patient with heart failure”). For them, 3 control visits and 8 phone calls were organized once a week. The participants of the control group were observed in the usual conditions of practical health care; 3 control visits to the doctor were provided for them. The results obtained at week 8 of the study showed that the number of complaints of foot and Shin edema decreased by 2 times compared to the initial data; in the control group, the frequency of complaints did not have a positive dynamic. Conclusion. Use of a diary of self-control is the easiest method of improving adherence of patients with CHF to treatment.

scholarly journals Evaluating Adherence to Medical Therapy in Patients with Chronic Heart Failure: Design and First Results of the COMPLIANCE Study

2020 ◽  
Vol 16 (4) ◽  
pp. 571-578
Author(s):  
S. Yu. Martsevich ◽  
E. T. Guseynova ◽  
N. P. Kutishenko ◽  
Yu. V. Lukina ◽  
S. N. Tolpygina ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Evidence Based ◽  
National Society ◽  
Adherence To Treatment ◽  
Long Term Outcome ◽  
First Results ◽  
Current Guidelines

Aim. To study the adherence of doctors to the guidelines for the treatment of chronic heart failure (СHF) and the adherence of patients with СHF to the therapy prescribed by doctors.Material and methods. The COMPLIANCE study is an integral part of the PROFILE registry of the specialized cardiology division of the research center. The study includes patients with verified CHF who were previously observed in the PROFILE registry and patients with CHF who have been newly seeking medical care in the period from December 01, 2019 to December 31, 2020. At the first visit, the initial therapy was evaluated, treatment adherence was determined, and treatment was corrected in accordance with current guidelines. The second visit will also assess patient adherence to treatment, assess the factors of non-adherence and complications of diseases during the year of follow-up.Results. The first 30 case-records of patients with CHF included into the study were analyzed. 90% of patients received angiotensin-converting enzyme inhibitors (ACEI)/angiotensin receptor blockers (ARB). Beta-blockers (BB) were prescribed to 96.7% of patients, and mineralocorticoid receptor antagonists (MRAs) – to 76.7% of patients, and some of them received MRAs at ejection fraction >35%. It was found that the overall adherence of patients according to the adherence scale of the Russian National Society of Evidence-Based Pharmacotherapy (NSEPh) was significantly lower than the adherence to specific drugs. The worst was adherence to ACEI (71%) and MRAs (77%), higher – to BB (86%). The most common factors of non-adherence to treatment, according to the first results, are a large number of medications and a complex medication regimen.Conclusion. The first part of the COMPLIANCE study showed a relatively good adherence of doctors to current guidelines. However, the choice of the drug and its doses did not always correspond to evidence-based medicine data, existing guidelines and summary of product characteristics (SmPC) of specific drugs. The patients adherence to the prescribed therapy was not bad (this can be explained by long-term follow-up in specialized centers), but it was different for different drugs. The worst adherence was registered to the ACEI/ARB. This is warning factor, since these drugs make a significant contribution to improving the long-term outcome of CHF.

scholarly journals Effect of frailty on treatment, hospitalisation and death in patients with chronic heart failure

2021 ◽  
Author(s):  
S. Sze ◽  
P. Pellicori ◽  
J. Zhang ◽  
J. Weston ◽  
I. B. Squire ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Clinical Frailty Scale ◽  
Mineralocorticoid Receptor Antagonist ◽  
Reduced Ejection Fraction ◽  
Frail Patients ◽  
History Of ◽  
Poor Outcomes ◽  
To Receive

Abstract Background Frailty is common in patients with chronic heart failure (CHF) and is associated with poor outcomes. The natural history of frail patients with CHF is unknown. Methods Frailty was assessed using the clinical frailty scale (CFS) in 467 consecutive patients with CHF (67% male, median age 76 years, median NT-proBNP 1156 ng/L) attending a routine follow-up visit. Those with CFS > 4 were classified as frail. We investigated the relation between frailty and treatments, hospitalisation and death in patients with CHF. Results 206 patients (44%) were frail. Of 291 patients with HF with reduced ejection fraction (HeFREF), those who were frail (N = 117; 40%) were less likely to receive optimal treatment, with many not receiving a renin–angiotensin–aldosterone system inhibitor (frail: 25% vs. non-frail: 4%), a beta-blocker (16% vs. 8%) or a mineralocorticoid receptor antagonist (50% vs 41%). By 1 year, there were 56 deaths and 322 hospitalisations, of which 25 (45%) and 198 (61%), respectively, were due to non-cardiovascular (non-CV) causes. Most deaths (N = 46, 82%) and hospitalisations (N = 215, 67%) occurred in frail patients. Amongst frail patients, 43% of deaths and 64% of hospitalisations were for non-CV causes; 58% of cardiovascular (CV) deaths were due to advancing HF. Among non-frail patients, 50% of deaths and 57% of hospitalisations were for non-CV causes; all CV deaths were due to advancing HF. Conclusion Frailty in patients with HeFREF is associated with sub-optimal medical treatment. Frail patients are more likely to die or be admitted to hospital, but whether frail or not, many events are non-CV. Graphical abstract

scholarly journals Calcium Channel Autoantibodies Predicted Sudden Cardiac Death and All-Cause Mortality in Patients with Ischemic and Nonischemic Chronic Heart Failure

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Haiyun Yu ◽  
Juanhui Pei ◽  
Xiaoyan Liu ◽  
Jingzhou Chen ◽  
Xian Li ◽  
...  
Keyword(s):  
Heart Failure ◽  
Multivariate Analysis ◽  
Sudden Cardiac Death ◽  
Chronic Heart Failure ◽  
Cardiac Death ◽  
Independent Predictor ◽  
All Cause Mortality ◽  
Patient Prognosis ◽  
The Relationship

The purpose of this study was to evaluate whether CC-AAbs levels could predict prognosis in CHF patients. A total of 2096 patients with CHF (841 DCM patients and 1255 ICM patients) and 834 control subjects were recruited. CC-AAbs were detected and the relationship between CC-AAbs and patient prognosis was analyzed. During a median follow-up time of 52 months, there were 578 deaths. Of these, sudden cardiac death (SCD) occurred in 102 cases of DCM and 121 cases of ICM. The presence of CC-AAbs in patients was significantly higher than that of controls (bothP<0.001). Multivariate analysis revealed that positive CC-AAbs could predict SCD (HR 3.191, 95% CI 1.598–6.369 for DCM; HR 2.805, 95% CI 1.488–5.288 for ICM) and all-cause mortality (HR 1.733, 95% CI 1.042–2.883 for DCM; HR 2.219, 95% CI 1.461–3.371 for ICM) in CHF patients. A significant association between CC-AAbs and non-SCD (NSCD) was found in ICM patients (HR = 1.887, 95% CI 1.081–3.293). Our results demonstrated that the presence of CC-AAbs was higher in CHF patients versus controls and corresponds to a higher incidence of all-cause death and SCD. Positive CC-AAbs may serve as an independent predictor for SCD and all-cause death in these patients.

scholarly journals Paradox of self-care gender differences among Italian patients with chronic heart failure: findings from a real-world cross-sectional study

BMJ Open ◽  
2018 ◽  
Vol 8 (9) ◽  
pp. e021966 ◽  
Author(s):  
Federica Dellafiore ◽  
Cristina Arrigoni ◽  
Francesco Pittella ◽  
Gianluca Conte ◽  
Arianna Magon ◽  
...  
Keyword(s):  
Heart Failure ◽  
Gender Differences ◽  
Chronic Heart Failure ◽  
Real World ◽  
Self Care ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Caregiver Relationship

AimThe aim of this study was to critically analyse and describe gender differences related to self-care among patients with chronic heart failure (HF).Methods and resultsA monocentric real-world cohort of 346 patients with chronic HF in follow-up was used for this cross-sectional study. We report data related to the cohort’s demographic and clinical characteristics. Self-care was assessed using the Self-Care of Heart Failure Index before patients’ discharge. After bivariate analysis, logistical regression models were used to describe the relationship between gender, self-care behaviours and self-care confidence. While men were found to have more than quadruple the risk of poor self-care than women (OR 4.596; 95% CI 1.075 to 19.650), men were also found to be approximately 60% more likely to have adequate self-care confidence than women (OR 0.412; 95% CI 0.104 to 0.962). Considering that self-care confidence is described as a positive predictor of behaviours, our results suggest a paradox. It is possible that the patient–caregiver relationship mediates the effect of confidence on behaviours. Overall, adequate levels of self-care behaviours are a current issue, ranging 7.6%–18.0%.ConclusionThis study sets the stage for future research where elements of the patient–caregiver relationship ought to be considered to inform the planning of appropriate educational interventions. We recommend routinely measuring patients’ self-care behaviours to guide their follow-up and as a basis for any changes in their daily life behaviours.

scholarly journals Quality of life in patients with chronic heart failure and their carers: a 3-year follow-up study assessing hospitalization and mortality

2010 ◽  
Vol 12 (9) ◽  
pp. 1002-1008 ◽  
Author(s):  
Javaid Iqbal ◽  
Loraine Francis ◽  
Janet Reid ◽  
Scott Murray ◽  
Martin Denvir
Keyword(s):  
Quality Of Life ◽  
Heart Failure ◽  
Chronic Heart Failure ◽  
Follow Up Study

Predicting mortality for patients with heart failure beyond oxygen consumption: a prognostic risk score

2021 ◽  
Author(s):  
Hanaa Shafiek ◽  
Andres Grau ◽  
Jaume Pons ◽  
Pere Pericas ◽  
Xavier Rossello ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Risk Score ◽  
Cardiac Transplantation ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Functional Evaluation ◽  
Cardiac Events ◽  
Ventricular Ejection Fraction

Background: Cardiopulmonary exercise test (CPET) is a crucial tool for the functional evaluation of cardiac patients. We hypothesized that VO2 max and VE/VCO2 slope are not the only parameters of CPET able to predict major cardiac events (mortality or cardiac transplantation urgently or elective). Objectives: We aimed to identify the best CPET predictors of major cardiac events in patients with severe chronic heart failure and to propose an integrated score that could be applied for their prognostic evaluation. Methods: We evaluated 140 patients with chronic heart failure who underwent CPET between 2011 and 2019. Major cardiac events were evaluated during follow-up. Univariate and multivariate logistic regression analysis were applied to study the predictive value of different clinical, echocardiographic and CPET parameters in relation to the major cardiac events. A score was generated and c-statistic was used for the comparisons. Results: Thirty-nine patients (27.9%) died or underwent cardiac transplantation over a median follow-up of 48 months. Five parameters (maximal workload, breathing reserve, left ventricular ejection fraction, diastolic dysfunction and non-idiopathic cardiomyopathy) were used to generate a risk score that had better risk discrimination than NYHA dyspnea scale, VO2 max, VE/VCO2 slope > 35 alone, and combined VO2 max and VE/VCO2 slope (p= 0.009, 0.004, < 0.001 and 0.005 respectively) in predicting major cardiac events. Conclusions: A composite score of CPET and clinical/echocardiographic data is more reliable than the single use of VO2max or combined with VE/VCO2 slope to predict major cardiac events.

scholarly journals Procalcitonin (PCT) Predicts Worse Outcome in Patients with Chronic Heart Failure with Reduced Ejection Fraction (HFrEF)

2018 ◽  
Vol 2018 ◽  
pp. 1-6 ◽  
Author(s):  
J. Banach ◽  
Ł. Wołowiec ◽  
D. Rogowicz ◽  
L. Gackowska ◽  
I. Kubiszewska ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Ejection Fraction ◽  
Roc Analysis ◽  
Diagnostic Marker ◽  
Lower Probability ◽  
Reduced Ejection Fraction ◽  
Probability Of Survival ◽  
Kaplan Meier

Introduction. Procalcitonin (PCT) is an excellent marker of sepsis but was not extensively studied in cardiology. The present study investigated PCT plasma concentration in patients with chronic heart failure with reduced ejection fraction (HFrEF) and its prognostic value during 24-month follow-up. Material and Methods. Study group consisted of 130 patients with HFrEF (LVEF ≤ 45%) and 32 controls. PCT level was assessed on admission in all patients. Telephone follow-up was performed every three months over a period of 2 years. Endpoints were death of all causes and readmission for HFrEF exacerbation. Results. HFrEF patients had significantly higher PCT concentration than controls (166.95 versus 22.15 pg/ml; p<0.001). Individuals with peripheral oedema had increased PCT comparing to those without oedema (217.07 versus 152.12 pg/ml; p<0.02). In ROC analysis, PCT turned out to be a valuable diagnostic marker of HFrEF (AUC 0.91; p<0.001). Kaplan-Meier survival curves revealed that patients with PCT in the 4th quartile had significantly lower probability of survival than those with PCT in the 1st and 2nd quartiles. In univariate, but not multivariate, analysis, procalcitonin turned out to be a significant predictor of death during 24-month follow-up. (HR 1.002; 95% CI 1.000–1.003; p<0.03). Conclusions. Elevated PCT concentration may serve as another predictor of worse outcome in patients with HFrEF.

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