Krueger Katrin, Botermann Lea, Schorr Susanne G, Griese-Mammen Nina, Laufs Ulrich, Schulz Martin
ABDA - Federal Union of German Associations of Pharmacists, Department of Medicine, Berlin, Germany.
ABDA - Federal Union of German Associations of Pharmacists, Department of Medicine, Berlin, Germany.
Int J Cardiol. 2015 Apr 1;184:728-735. doi: 10.1016/j.ijcard.2015.03.042. Epub 2015 Mar 4.
Chronic heart failure (CHF) is prevalent among the elderly and is characterized by high mortality and hospitalization rates. Non-adherence to medications is frequent and related to poor clinical outcomes. It is often assumed that older age is related to poorer medication adherence compared with younger age. We analyzed the existing evidence of age as a determinant of medication adherence in patients with CHF.
A systematic search of the bibliographic database MEDLINE and all Cochrane databases was performed. Studies were included if they examined medication adherence in adult patients with CHF, evaluated factors contributing to medication adherence, and analyzed the relationship between age and medication adherence. Articles classified as studies with poor quality were excluded.
A total of 1565 titles were found, and ultimately, 17 studies, which provide data for a total of 162,727 patients, were analyzed. Seven studies showed a statistically significant relationship between age and medication adherence: six articles demonstrated that increased age is correlated with higher medication adherence, and one study showed that patients in the age range of 57 to 64 years are affected by non-adherence to angiotensin-converting enzyme inhibitors. Ten studies found no significant relationship.
The results suggest that older age alone is not related to poorer medication adherence compared with younger patients with CHF. More attention should be paid to younger newly-diagnosed patients with CHF. Future studies are required to explore medication adherence in CHF in different, standardized, and specific age groups and should be sufficiently powered to assess clinical endpoints.
慢性心力衰竭（CHF）在老年人中很常见，其特点是死亡率和住院率高。不坚持服药的情况很常见，且与不良临床结局相关。人们通常认为，与年轻患者相比，老年患者的服药依从性较差。我们分析了年龄作为CHF患者服药依从性决定因素的现有证据。
对文献数据库MEDLINE和所有Cochrane数据库进行系统检索。纳入的研究需满足以下条件：研究CHF成年患者的服药依从性、评估影响服药依从性的因素以及分析年龄与服药依从性之间的关系。质量较差的研究文章被排除。
共检索到1565篇文献，最终分析了17项研究，这些研究共纳入162727例患者的数据。7项研究显示年龄与服药依从性之间存在统计学显著关系：6篇文章表明年龄增长与更高的服药依从性相关，1项研究表明57至64岁年龄段的患者存在不坚持服用血管紧张素转换酶抑制剂的情况。10项研究未发现显著关系。
结果表明，与年轻的CHF患者相比，仅年龄因素与较差的服药依从性无关。应更多关注新诊断的年轻CHF患者。未来的研究需要探索不同、标准化和特定年龄组CHF患者的服药依从性，并且应有足够的样本量来评估临床终点。
