University of Kentucky, College of Nursing, Lexington, KY 40536-0232, USA.
J Card Fail. 2010 Feb;16(2):142-9. doi: 10.1016/j.cardfail.2009.10.017. Epub 2009 Dec 11.
Rehospitalization rates are higher in African American than Caucasian patients with heart failure (HF). The reasons for the disparity in outcomes between African Americans and Caucasians may relate to differences in medication adherence. To determine whether medication adherence is a mediator of the relationship between ethnicity and event-free survival in patients with HF.
Medication adherence was monitored longitudinally in 135 HF patients using the Medication Event Monitoring System. Events (emergency department visits for HF exacerbation, HF and cardiac rehospitalization, and all-cause mortality) were obtained by interview and hospital data base review. A series of regression models and survival analyses was conducted to determine whether medication adherence mediated the relationship between ethnicity and event-free survival. Event-free survival was significantly worse in African Americans than Caucasians. Ethnicity was a predictor of medication adherence (P=.011). African Americans were 2.57 times more likely to experience an event than Caucasians (P=.026). Ethnicity was not a predictor of event-free survival after entering medication adherence in the model (P=.06).
Medication adherence was a mediator of the relationship between ethnicity and event-free survival in this sample. Interventions designed to reduce barriers to medication adherence may decrease the disparity in outcomes.
心力衰竭（HF）患者中，非裔美国人的再住院率高于白种人。非裔美国人和白种人之间在结局方面存在差异的原因可能与药物依从性的差异有关。为了确定药物依从性是否是 HF 患者的种族与无事件生存之间关系的中介因素。
使用药物事件监测系统对 135 例 HF 患者进行了纵向监测药物依从性。通过访谈和医院数据库回顾获取事件（HF 恶化的急诊就诊、HF 和心脏再住院以及全因死亡率）。进行了一系列回归模型和生存分析，以确定药物依从性是否介导了种族与无事件生存之间的关系。非裔美国人的无事件生存率明显低于白种人。种族是药物依从性的预测因素（P=.011）。非裔美国人发生事件的可能性是白种人的 2.57 倍（P=.026）。在模型中纳入药物依从性后，种族不是无事件生存的预测因素（P=.06）。
在该样本中，药物依从性是种族与无事件生存之间关系的中介因素。旨在减少药物依从性障碍的干预措施可能会减少结局方面的差异。
