心力衰竭患者的药物依从性、社会支持和无事件生存。
Medication adherence, social support, and event-free survival in patients with heart failure.
机构信息
Department of Adult/Geriatric Health, School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7460, USA.
出版信息
Health Psychol. 2013 Jun;32(6):637-46. doi: 10.1037/a0028527. Epub 2012 Jul 2.
OBJECTIVES
Medication adherence and perceived social support (PSS) are independent predictors of mortality in patients with heart failure (HF). However, the predictive power of the combination of medication adherence and PSS for hospitalization and death has not been investigated in patients with HF. The purpose of the study was to explore the combined influence of medication adherence and PSS for prediction of cardiac event-free survival in patients with HF.
METHOD
A total of 218 HF patients monitored medication adherence for 1-3 months and completed the Multidimensional Perceived Social Support Scale (MPSSS) at baseline. Medication adherence was measured using a valid and objective measure, the Medication Event Monitoring System (MEMS). Patients were followed for up to 3.5 years to collect data about cardiac event-free survival (i.e., cardiac emergency department visits, hospitalizations, and death). To test the association of the combination of medication adherence and PSS with outcomes, the interaction term of medication adherence and PSS was first entered in a Cox regression to predict outcomes. Second, patients were grouped using an evidence-based cutpoint of 88% for medication adherence from the MEMS data and a median score 71 of the MPSSS. Kaplan-Meier and Cox proportional hazards models were used to compare cardiac event-free survival among groups.
RESULT
Medication adherence and PSS were independent predictors of cardiac event-free survival (p = .006 and .021, respectively). Patients with medication nonadherence and lower PSS had a 3.5 times higher risk of cardiac events than those who were adherent and had higher PSS.
CONCLUSION
Medication adherence mediated the relationship between PSS and cardiac event-free survival in this sample. Moreover, medication adherence and social support independently, and in combination, predicted cardiac event-free survival in patients with HF. Interventions to improve clinical outcomes should address medication adherence and social support.
目的
药物依从性和感知社会支持（PSS）是心力衰竭（HF）患者死亡率的独立预测因素。然而，HF 患者药物依从性和 PSS 相结合对住院和死亡的预测能力尚未得到研究。本研究旨在探讨药物依从性和 PSS 相结合对 HF 患者心脏事件无事件生存率的预测作用。
方法
共监测了 218 例 HF 患者 1-3 个月的药物依从性，并在基线时完成了多维感知社会支持量表（MPSSS）。使用有效的客观测量方法，即药物事件监测系统（MEMS）来测量药物依从性。对患者进行了长达 3.5 年的随访，以收集关于心脏事件无事件生存率（即心脏急诊就诊、住院和死亡）的数据。为了检验药物依从性和 PSS 结合对结局的关联，首先将药物依从性和 PSS 的交互项纳入 Cox 回归以预测结局。其次，根据 MEMS 数据中 88%的药物依从性和 MPSSS 的中位数 71 分，将患者分为药物依从性和 PSS 低分组。使用 Kaplan-Meier 和 Cox 比例风险模型比较各组之间的心脏事件无事件生存率。
结果
药物依从性和 PSS 是心脏事件无事件生存率的独立预测因素（p =.006 和.021）。药物不依从和 PSS 较低的患者发生心脏事件的风险比依从性高和 PSS 高的患者高 3.5 倍。
结论
在本样本中，药物依从性介导了 PSS 与心脏事件无事件生存率之间的关系。此外，药物依从性和社会支持独立且结合起来，可预测 HF 患者的心脏事件无事件生存率。改善临床结局的干预措施应同时解决药物依从性和社会支持问题。
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