TriService Nursing Research Program, Uniformed Services University of the Health Sciences, Frederick, Maryland 21702, USA.
Heart Lung. 2011 Sep-Oct;40(5):393-404. doi: 10.1016/j.hrtlng.2011.02.002. Epub 2011 Mar 30.
We investigated the relationship between anxiety and event-free survival (ie, composite endpoint of death, emergency department visits, or hospitalizations) for patients with heart failure (HF), and examined whether behavioral and physiologic mechanisms mediate any association between anxiety and outcomes.
In this longitudinal study, patients with HF completed the anxiety subscale of the Brief Symptom Inventory, and heart-rate variability and plasma norepinephrine levels were measured. Dietary adherence and medication adherence were measured according to 24-hour urine sodium level and the Medication Event Monitoring System, respectively. Patients were followed at least 1 year for event-free survival.
In total, 147 patients were enrolled. Patients with high anxiety had a shorter (hazard ratio, 2.2; 95% confidence interval, 1.1-4.3; P = .03) period of event-free survival than patients with lower anxiety. Anxiety independently predicted adherence to medication (P = .008), which in turn predicted event-free survival (hazard ratio, 2.0; 95% confidence interval, 1.2-3.3; P = .008). The effect of anxiety (P = .17) on event-free survival was less significant when the regression model included both anxiety and adherence to medication than when the model only included anxiety (P = .03), indicating that adherence to medication mediated the relationship between anxiety and event-free survival.
This is the first study to show that nonadherence to medication links anxiety and event-free survival for patients with HF. Interventions that reduce anxiety and improve adherence may benefit outcomes.
我们研究了心力衰竭（HF）患者的焦虑与无事件生存（即死亡、急诊就诊或住院的复合终点）之间的关系，并探讨了行为和生理机制是否介导了焦虑与结局之间的任何关联。
在这项纵向研究中，HF 患者完成了Brief Symptom Inventory 的焦虑子量表，并且测量了心率变异性和血浆去甲肾上腺素水平。根据 24 小时尿钠水平和药物事件监测系统分别测量了饮食依从性和药物依从性。患者至少随访 1 年以获得无事件生存。
共纳入 147 例患者。高焦虑患者的无事件生存时间更短（风险比，2.2；95%置信区间，1.1-4.3；P =.03）。焦虑独立预测药物依从性（P =.008），而药物依从性又预测无事件生存（风险比，2.0；95%置信区间，1.2-3.3；P =.008）。当回归模型同时包含焦虑和药物依从性时，焦虑对无事件生存的影响（P =.17）不如仅包含焦虑时显著（P =.03），这表明药物依从性介导了焦虑与无事件生存之间的关系。
这是第一项表明 HF 患者的药物不依从与焦虑和无事件生存相关的研究。减少焦虑和提高药物依从性的干预措施可能有益于改善结局。
