190687 Association between adherence to treatment, clinical risk factors, and quality of life among congestive heart failure patients

Wednesday, October 29, 2008: 10:50 AM

Evan G. Birnholz, MPH , Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
Longjian Liu, MD, PhD, MSc , Department of Epidemiology and Biostatistics, Drexel University School of Public Health, Philadelphia, PA
Howard J. Eisen, MD , Department of Cardiology, Hahnemann University Hospital, Philadelphia, PA
Background: Congestive heart failure (CHF) is a disorder affecting millions of Americans. Few studies have examined co-morbid conditions and other risk factors in relation to patient adherence to treatment and quality of life (QoL). Methods: 125 CHF patients participated in a cross-sectional survey study at Hahnemann Hospital in Philadelphia, Pennsylvania between January-April of 2008. Questionnaires on patients' adherence status (Patient Behavior Survey) and QoL (Minnesota Living with Heart Failure Questionnaire) were used in the study. Co-morbid diagnoses were confirmed through medical chart review. Adherence scores were adjusted to control for exercise intolerance, physical disability, and recent hospitalization. Survey and medical record data were analyzed using univariate and multivariate statistical tests. Results: Subjects who gained 5 lbs or more during the past month had 11.6% lower adherence scores compared to subjects reporting no weight gain after controlling for gender, race, age, education, angina, renal disease, and valvular disease (p<0.01). Worsening New York Heart Association (NYHA) class was strongly associated with poor QoL when adjusting for similar covariates (p<0.001). Compared to white patients, ethnic minority subjects were significantly more likely to be unemployed, have an income below $50,000 per year, and be recently hospitalized for CHF exacerbation. Weight gain was significantly associated with worsening NYHA class (p<0.01). Conclusions: Aggressive weight control may reduce the risk of decompensated CHF. Strategies designed to increase adherence to weight monitoring among underprivileged individuals and those with multiple co-morbidities may help improve CHF patient outcomes.

Learning Objectives:
1. Assess the physical, emotional, and overall quality of life among a subset of congestive heart failure patients. 2. Determine the significant predictors of patient adherence to physician-recommended treatment guidelines. 3. Identify the effects of co-morbid cardiovascular diseases on patient adherence and quality of life. 4. Evaluate the relationship between adherence behavior and quality of life.

Keywords: Adherence, Quality of Life

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: This report was completed and presented to the faculty of Drexel University School of Public Health in partial fulfillment of the requirement for the degree of Master of Public Health. I have read the APHA policy on full disclosure and I declare that I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.