Department of Primary Medical Care, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistraße, Hamburg.
Department of Primary Medical Care, University of Luebeck, Ratzeburger Allee 160, 23538 Luebeck.
Fam Pract. 2020 Oct 19;37(5):695-702. doi: 10.1093/fampra/cmaa042.
Psychological distress has a negative impact on the prognosis and quality of life for patients with heart failure. We investigated the association between psychological distress and the patients' adherence to medical treatment (medication adherence) and self-care advice (lifestyle adherence) in heart failure. We further examined whether there are different factors associated with low medication compared to low lifestyle adherence.
This secondary analysis of the RECODE-HF cohort study analyzed baseline data of 3099 primary care heart failure patients aged 74 ± 10 years, 44.5 % female. Using multivariable regression, factors relating to medication and lifestyle adherence were investigated in order to estimate the extent to which these factors confound the association between psychological distress and adherence.
Psychological distress was significantly associated with poorer medication adherence but not with lifestyle adherence after controlling for confounders. We identified different factors associated with medication compared to lifestyle adherence. A higher body mass index, a less developed social network, living alone, fewer chronic co-morbidities and unawareness of the heart failure diagnosis were only related to lower lifestyle adherence. Higher education was associated with poorer medication adherence. Male sex, younger age, lower self-efficacy and less familiar relation with the general practitioner were common factors associated with both lower medication and lifestyle adherence.
Promising factors for increasing medication adherence (reduction of psychological distress) and lifestyle adherence (explaining the patient his/her heart failure diagnosis more than once and increase in the patients' self-efficacy), which were found in this cross-sectional study, must be further investigated in longitudinal studies.
心理困扰对心力衰竭患者的预后和生活质量有负面影响。我们研究了心理困扰与心力衰竭患者对药物治疗（药物依从性）和自我保健建议（生活方式依从性）的依从性之间的关系。我们进一步研究了是否存在与药物依从性低相比与生活方式依从性低相关的不同因素。
本研究对 RECODE-HF 队列研究的二次分析纳入了 3099 名年龄为 74 ± 10 岁、44.5%为女性的初级保健心力衰竭患者的基线数据。使用多变量回归，研究了与药物和生活方式依从性相关的因素，以估计这些因素在多大程度上混淆了心理困扰与依从性之间的关系。
在控制混杂因素后，心理困扰与药物依从性较差显著相关，但与生活方式依从性无关。我们发现了与药物依从性相比与生活方式依从性相关的不同因素。较高的体重指数、较少的社会网络、独居、较少的慢性合并症和对心力衰竭诊断的认识不足，仅与较低的生活方式依从性相关。较高的教育程度与药物依从性较差相关。男性、年龄较小、自我效能较低以及与全科医生的关系不熟悉，是与药物和生活方式依从性均相关的常见因素。
本横断面研究发现了增加药物依从性（减少心理困扰）和生活方式依从性（向患者多次解释其心力衰竭诊断并提高患者自我效能）的有希望因素，必须在纵向研究中进一步研究。
