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

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.