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

Abstract

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.

The multiple mediating effects of illness perceptions and coping strategies on the relationship between physical symptoms and depressive symptoms in patients with heart failure

“…29 However, it was lower than that (50.7%) reported by Bhatt et al 30 The variation in prevalence may be attributed to the different screening tools and illness severity. Since depressive symptoms contribute to the increase in patients' hospitalizations, readmissions and mortality, and poor health-related quality of life, [7][8][9] it is essential to recognize and manage the depressive symptoms in patients with heart failure. This study showed that illness perceptions mediated the relationship between physical symptoms and depressive symptoms in heart failure patients, consistent with previous studies.…”

“…6 Depressive symptoms have been found to contribute to increasing hospitalizations, readmissions and mortality and to a reduction in health-related quality of life in patients with heart failure. [7][8][9] To manage depressive and physical symptoms, it is essential to identify modifiable associated factors and the underlying mechanism between them in patients with heart failure.…”

Changes in Treatment of Very Elderly Patients Six Weeks after Discharge from Geriatrics Department

“…Nonadherence to medication is related to several factors including a higher prevalence of chronic diseases, polypharmacy, and age-related physical and mental capabilities [ 5 ]. Disease severity may improve treatment adherence [ 28 ] whereas certain comorbidities such as depression, cognitive impairment or high blood pressure increase the risk of nonadherence [ 29 , 30 , 31 ]. In our study, there were significantly more changes when the patient had cognitive impairment.…”

Patients’ treatment adherence after coronary bypass surgery in terms of their psychosocial characteristics

“…Повышение значимости роли пациента в лечебном процессе, его активное в нем участие в настоящий момент актуально и для кардиохирургической клиники, поскольку успешность восстановления больного после хирургического вмешательства на сердце и коронарных артериях, а также длительность эффекта от него напрямую зависят от того, будет ли пациент воспринимать свою болезнь всерьез и следовать рекомендациям врачей (Wu, Frazier, Rayens et al 2013;Gathright, Dolansky, Gunstad et al 2017). При этом, согласно статистике Европейского общества кардиологов, смертность от ишемической болезни сердца (ИБС) в России -одна из самых высоких в Европе (Townsend, Wilson, Bhatnagar et al 2016).…”