心力衰竭患者认知功能较差与客观监测的药物依从性降低之间的关联。
Association Between Poorer Cognitive Function and Reduced Objectively Monitored Medication Adherence in Patients With Heart Failure.
作者信息
Dolansky Mary A, Hawkins Misty A W, Schaefer Julie T, Sattar Abdus, Gunstad John, Redle Joseph D, Josephson Richard, Moore Shirley M, Hughes Joel W
机构信息
From the Frances Payne Bolton School of Nursing (M.A.D., A.S., S.M.M.), Department of Epidemiology & Biostatistics (A.S.), and School of Medicine (R.J.), Case Western Reserve University, Cleveland, OH; Department of Psychology, Oklahoma State University, Stillwater (M.A.W.H.); Department of Psychological Sciences, Kent State University, OH (J.T.S., J.G., J.W.H.); Cardiovascular Institute, Summa Health System, Akron City Hospital, OH (J.D.R., J.W.H.); and Harrington Heart & Vascular Institute, University Hospitals, Cleveland, OH (R.J.).
出版信息
Circ Heart Fail. 2016 Dec;9(12). doi: 10.1161/CIRCHEARTFAILURE.116.002475.
BACKGROUND
Subclinical cognitive impairment is prevalent in heart failure (HF); however, its role in important clinical outcomes, such as HF treatment adherence, is unclear. Given the complex polypharmacy in HF treatment, cognitive deficits may be important in predicting medication management. Thus, the objective of the current study was to examine the impact of cognitive function on medication adherence among community-dwelling patients with HF using objective assessments.
METHODS AND RESULTS
A prospective observational cohort design of 309 community-dwelling patients with HF (59.7% male, 68.7±9.7 years) and no history of dementia or neurological disease. Cognition was assessed using a neuropsychological battery at baseline. Medication adherence was objectively measured for 21 days using an electronic pillbox. Regression analyses tested whether attention, executive function, or memory predicted 21-day medication adherence. In unadjusted analyses, lower scores on all 3 cognitive domains predicted poorer medication adherence (β=0.52-85; P=0.001-0.009). After adjusting for demographic, clinical, and psychosocial variables, memory continued to predict medication adherence (β=0.51; P=0.008), whereas executive function (β=0.24; P=0.075) and attention were no longer a predictor (β=0.34; P=0.131).
CONCLUSIONS
Poorer cognitive function, especially in regard to memory, predicted reduced medication adherence among patients with HF and no history of dementia. This effect remained after adjustment for factors known to predict adherence, such as depressed mood, social support, and disease severity level. Future studies should examine the link from cognitive impairment and medication nonadherence to clinical outcomes (eg, hospitalization and mortality).
CLINICAL TRIAL REGISTRATION
URL: http://www.clinicaltrials.gov. Unique identifier: NCT01461629.
背景
亚临床认知障碍在心力衰竭（HF）患者中普遍存在；然而，其在诸如HF治疗依从性等重要临床结局中的作用尚不清楚。鉴于HF治疗中复杂的联合用药情况，认知缺陷在预测药物管理方面可能很重要。因此，本研究的目的是使用客观评估方法来研究认知功能对社区居住的HF患者药物依从性的影响。
方法与结果
对309名社区居住的HF患者（男性占59.7%，年龄68.7±9.7岁）进行前瞻性观察队列设计，这些患者无痴呆或神经疾病病史。在基线时使用神经心理测验评估认知功能。使用电子药盒客观测量21天的药物依从性。回归分析测试注意力、执行功能或记忆力是否能预测21天的药物依从性。在未调整的分析中，所有3个认知领域的得分较低均预示着药物依从性较差（β=0.52 - 85；P=0.001 - 0.009）。在调整了人口统计学、临床和社会心理变量后，记忆力仍然可以预测药物依从性（β=0.51；P=0.008），而执行功能（β=0.24；P=0.075）和注意力不再是预测因素（β=0.34；P=0.131）。
结论
认知功能较差，尤其是记忆力方面，预示着无痴呆病史的HF患者药物依从性降低。在调整了已知可预测依从性的因素（如情绪低落、社会支持和疾病严重程度）后，这种效应仍然存在。未来的研究应探讨认知障碍和药物不依从与临床结局（如住院和死亡率）之间的联系。
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