Association Between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients With Heart Failure

Dolansky, Mary A.; Hawkins, Misty A.W.; Schaefer, Julie T.; Sattar, Abdus; Gunstad, John; Redle, Joseph D.; Josephson, Richard; Moore, Shirley; Hughes, Joel W.

doi:10.1161/circheartfailure.116.002475

Cited by 71 publications

(75 citation statements)

References 39 publications

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“…The present study is a secondary analysis from the Heart Adherence, Behavior, and Cognition (HeartABC) study (Trial Identifier: NCT01461629), which was a longitudinal, observational study of the impact of psychosocial and cognitive factors on self-care behaviors in older adults with HF (Dolansky et al, in press; Dolansky et al, 2016). The HeartABC study enrolled 372 older adults with HF, of which 308 had complete data for the variables of interest in this report.…”

Section: Methodsmentioning

confidence: 99%

The impact of medication nonadherence on the relationship between mortality risk and depression in heart failure.

Gathright¹,

Dolansky²,

Gunstad³

et al. 2017

Health Psychology

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Objective Heart failure affects over 5 million U.S. adults and approximately 20% of individuals with heart failure experience depressive symptoms. Depression is detrimental to prognosis in heart failure, conferring approximately a 2-fold increase in mortality risk. Medication non-adherence may help explain this relationship, as depressed patients are less likely to adhere to the medication regimen. Methods Depression, electronically-monitored medication adherence, and mortality were measured in a sample of 308 patients with heart failure participating in a study of self-management behavior. Cardiovascular and all-cause mortality data were obtained from the Centers for Disease Control and Prevention’s National Death Index (median 2.9 year follow-up). Cox proportional hazards regression was used to assess the relationship between depression and mortality, with and without adjustment for age, gender, disease severity, and medication non-adherence. Results In adjusted analyses, depression was associated with increased all-cause mortality risk, (HR: 1.87; 95% CI: 1.04 – 3.37). Depression was not related to cardiovascular mortality, potentially due to a low number of cardiac-related deaths. When medication non-adherence was added to the model, non-adherence (HR: 1.01; 95% CI: 1.004 – 1.02), but not depression, predicted all-cause mortality risk. Conclusions Depressive symptoms confer increased all-cause mortality risk in heart failure, and medication non-adherence contributes to this relationship. Depression and non-adherence represent potentially modifiable risk factors for poor prognosis. Future research is needed to understand whether interventions that concomitantly target these factors can improve outcomes.

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Section: Methodsmentioning

confidence: 99%

The impact of medication nonadherence on the relationship between mortality risk and depression in heart failure.

Gathright¹,

Dolansky²,

Gunstad³

et al. 2017

Health Psychology

Self Cite

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“…In our study, patients in the low proficiency group for self‐care had lower MMSE scores and poorer executive function (the vast majority of them were unable to perform the trail‐making test that evaluates it). These subtle disabilities are frequently associated with frailty and aggravated with hospitalization, and often not specifically assessed or ignored in clinical practice even if they have been shown to be associated with self‐care ability, medication adherence, and outcomes . Lower levels of health literacy and education have been pointed out as associated with poor HF self‐care ability by others .…”

Section: Discussionmentioning

confidence: 99%

Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self‐care: impact on outcomes

Vidán

Martín‐Sánchez

Sánchez

et al. 2019

European J of Heart Fail

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Aim To evaluate the abilities to perform essential tasks for heart failure (HF) self‐management in elderly patients, and its influence on post‐discharge prognosis. Methods and results Overall, 415 patients ≥70 years old hospitalized for HF were included and followed during 1 year. The ability to perform six specific tasks (use of a scale, weight registration, diuretic identification, knowledge of salted foods, oedema identification, and treatment adjustment) was tested and distributed on terciles (T) of performance. Correlation with the self‐administered questionnaire European HF Self‐care Behaviour Scale (EHFScBS) was evaluated. The independent influence of self‐care on 1‐year mortality and readmission risks was calculated by Cox proportional hazards regression analysis. Mean age was 80.1 years. On average, patients could perform 2.9 ± 1.6 of self‐care tasks, and only 5.3% could perform the six tasks correctly. Patients with previous HF self‐care education had slight better performance (3.2 ± 1.6 vs 2.8 ± 1.6, P < 0.02). A weak correlation was found between EHFScBS and number of tasks correctly performed (r = −0.135; P = 0.006). One‐year mortality in T1, T2, and T3 patients was 33.0%, 20.7%, and 14.1%, respectively (P = 0.002). Multivariable analysis showed T2 and T3 groups having a lower adjusted mortality risk compared with T1 [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.32–1.03; and HR 0.40; 95% CI 0.21–0.77, respectively], without differences in readmissions. Conclusion Most elderly patients admitted for HF are unable to perform several essential tasks needed for HF self‐care. Self‐perception of care was poorly correlated with real ability, and poor self‐care ability was associated with higher 1‐year mortality risk.

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“…The decision to undergo HIV testing and the subsequent processing of status knowledge likely requires a relatively high cognitive load to understand the meaning of testing, accurately perceive risk, weigh the costs and benefits and navigate testing logistics . The relationship between cognitive function and other areas of engagement in medical care – treatment choice and treatment adherence – has been established. However, we are not aware of previous studies that have examined the relationship between cognitive function and HIV status knowledge.…”

Section: Introductionmentioning

confidence: 99%

The relationships between cognitive function, literacy and HIV status knowledge among older adults in rural South Africa

et al. 2020

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Introduction Although HIV prevalence is exceptionally high in South Africa, HIV testing rates remain below targeted guidelines. Older adults living with HIV are substantially more likely to remain undiagnosed than younger people. Cognitive function and literacy could play key roles in HIV status knowledge due to the decision‐making processes required around weighing the costs and benefits of testing, navigating testing logistics and processing results. We aimed to assess the independent relationships among each of cognitive function, literacy and education with HIV status knowledge in a population‐based sample of older adults living in a rural South African community with high HIV prevalence. Methods We analyzed data from a population‐based study of 5059 men and women aged 40 years and older in rural South Africa (Health and Aging in Africa: A Longitudinal Study of an INDEPTH community (HAALSI)). HAALSI surveys, conducted between 2014 and 2015, queried self‐reported literacy, educational attainment and HIV status knowledge. Laboratory tests were conducted to assess true HIV sero‐status. Cognitive function was assessed with a battery of cognitive tests measuring time orientation, immediate and delayed recall, and numeracy and coded using confirmatory factor analysis as a z‐standardized latent variable. We estimated the relationship between the outcome of HIV status knowledge and each of three exposures: (1) latent cognitive z‐score, (2) literacy and (3) education, using confounder‐adjusted modified Poisson regression models in the study population overall and stratified by HIV sero‐status. Results We found that HIV status knowledge was higher among those with higher cognitive z‐scores (adjusted Prevalence Ratio (aPR) (95% CI): 1.18 (1.14, 1.21) per standard deviation unit), and among literate participants (aPR (95% CI): 1.24 (1.16, 1.32) vs. non‐literate participants). Taken together, the associations with literacy and cognitive function completely attenuated the otherwise positive association between educational attainment and HIV status knowledge. The magnitudes of effect were generally similar among laboratory‐confirmed HIV‐negative and HIV‐positive participants. Conclusions Campaigns that target older adults in rural South Africa with HIV testing messages should carefully consider the cognitive and literacy levels of the intended audience. Innovations to ease the cognitive load associated with HIV testing could prove fruitful to increase HIV status knowledge.

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Association Between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients With Heart Failure

Cited by 71 publications

References 39 publications

The impact of medication nonadherence on the relationship between mortality risk and depression in heart failure.

The impact of medication nonadherence on the relationship between mortality risk and depression in heart failure.

Most elderly patients hospitalized for heart failure lack the abilities needed to perform the tasks required for self‐care: impact on outcomes

The relationships between cognitive function, literacy and HIV status knowledge among older adults in rural South Africa

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