Duke University Health System, Duke University School of Nursing, Durham, NC 27710, USA.
Eur J Heart Fail. 2009 Nov;11(11):1092-8. doi: 10.1093/eurjhf/hfp142.
Although many patients with heart failure have incomplete adherence to prescribed medications, predisposing factors remain unclear. This analysis investigates factors associated with adherence, with particular emphasis on age and sex.
A multivariable regression analysis of 7599 heart failure patients from the CHARM trial was done to evaluate factors associated with adherence. Adherence was measured as the proportion of time patients took more than 80% of study medication. The mean age was 66 years (SD 11) and 31.5% (n = 2400) were women. Women were slightly less adherent than men (87.3 vs. 89.8%, P = 0.002), even in adjusted, multivariable models (treatment, P = 0.006; placebo P = 0.004; and overall P < 0.001). However, all-cause mortality was lower in women (21.5%) than in men (25.3%) (adjusted hazard ratio, 0.77; 95% CI, 0.69-0.86; P < 0.001), but patients with a low adherence regardless of sex had a higher mortality. Age, severity of heart failure, number of medications, and smoking status were not associated with adherence.
Women, particularly those <75 years of age, were less likely to be adherent in this large sample of patients with symptomatic heart failure. Understanding factors associated with adherence may provide opportunities for intervention.
尽管许多心力衰竭患者对规定药物的依从性不完全，但导致这种情况的潜在因素仍不清楚。本分析旨在研究与依从性相关的因素，尤其关注年龄和性别。
对 CHARM 试验中的 7599 例心力衰竭患者进行了多变量回归分析，以评估与依从性相关的因素。依从性的衡量标准为患者服用超过 80%研究药物的时间比例。平均年龄为 66 岁（标准差 11 岁），31.5%（n=2400）为女性。女性的依从性略低于男性（87.3%比 89.8%，P=0.002），即使在调整后的多变量模型中也是如此（治疗，P=0.006；安慰剂，P=0.004；总体，P<0.001）。然而，女性的全因死亡率（21.5%）低于男性（25.3%）（调整后的危险比，0.77；95%置信区间，0.69-0.86；P<0.001），但无论性别如何，低依从性患者的死亡率更高。年龄、心力衰竭严重程度、药物数量和吸烟状况与依从性无关。
在这个大型有症状心力衰竭患者样本中，女性，尤其是年龄<75 岁的女性，不太可能依从治疗。了解与依从性相关的因素可能为干预提供机会。
