Biobehavioral Research Center, University of Pennsylvania School of Nursing, 418 Curie Boulevard, Philadelphia, PA 19104-4217, USA.
Circ Heart Fail. 2012 Jul 1;5(4):430-6. doi: 10.1161/CIRCHEARTFAILURE.111.965152. Epub 2012 May 30.
Medication nonadherence rates are high. The factors predicting nonadherence in heart failure remain unclear.
A sample of 202 adults with heart failure was enrolled from the northeastern United States and followed for 6 months. Specific aims were to describe the types of objectively measured medication adherence (eg, taking, timing, dosing, drug holidays) and to identify contributors to nonadherence 6 months after enrollment. Latent growth mixture modeling was used to identify distinct trajectories of adherence. Indicators of the 5 World Health Organization dimensions of adherence (socioeconomic, condition, therapy, patient, and healthcare system) were tested to identify contributors to nonadherence. Two distinct trajectories were identified and labeled persistent adherence (77.8%) and steep decline (22.3%). Three contributors to the steep decline in adherence were identified. Participants with lapses in attention (adjusted OR, 2.65; P=0.023), those with excessive daytime sleepiness (OR, 2.51; P=0.037), and those with ≥2 medication dosings per day (OR, 2.59; P=0.016) were more likely to have a steep decline in adherence over time than to have persistent adherence.
Two distinct patterns of adherence were identified. Three potentially modifiable contributors to nonadherence have been identified.
药物依从性率很高。预测心力衰竭患者不依从的因素仍不清楚。
从美国东北部招募了 202 名心力衰竭成年人作为样本，并随访 6 个月。具体目的是描述客观测量的药物依从性的类型（例如，服用、时间、剂量、药物假期），并确定 6 个月后不依从的原因。潜在增长混合建模用于确定依从性的不同轨迹。测试了 5 个世界卫生组织依从性维度（社会经济、病情、治疗、患者和医疗保健系统）的指标，以确定不依从的原因。确定了两种不同的依从性轨迹，分别标记为持续依从性（77.8%）和急剧下降（22.3%）。确定了导致依从性急剧下降的三个原因。注意力不集中的参与者（调整后的 OR，2.65；P=0.023）、白天过度嗜睡的参与者（OR，2.51；P=0.037）和每天服用≥2 次药物的参与者（OR，2.59；P=0.016）比持续依从性更有可能随着时间的推移而出现依从性急剧下降。
确定了两种不同的依从性模式。已经确定了三个潜在可改变的不依从原因。
