Elsevier

Heart & Lung

Volume 30, Issue 4, July–August 2001, Pages 294-301
Heart & Lung

Issues in Cardiovascular Care
Relationship between psychosocial variables and compliance in patients with heart failure*,**,

https://doi.org/10.1067/mhl.2001.116011Get rights and content

Abstract

Objective: The purpose of this study was to describe the socio-demographic, psychosocial, and social support variables that predict compliance to treatment regimens in HF patients. Design And Setting: Semistructured interviews were conducted on 82 patients at an outpatient heart failure clinic to gather data related to compliance behaviors. Five standardized instruments were used to gather data on patients' psychosocial health status and perceived social support. Results: The overall compliance rate was 85.13 (10.01%). Higher levels of compliance (>90%) were noted for follow-up appointments, medications, smoking, and alcohol cessation. Poor compliance was observed with dietary and exercise recommendations (71% and 53%, respectively). In a multivariate model, higher education, higher mental and physical health status, and neuroticism independently contributed to 24% of the variance in overall compliance. Conclusion: The study supports that HF patients had poor compliance with dietary and exercise regimens. Since following a dietary and exercise regimen has been demonstrated to reduce morbidity in this population, strategies to increase compliance should be rigorously pursued.

Section snippets

Study subjects and data source

The appropriate Institutional Review Board reviewed and approved the study. The convenience sample included 82 persons who were older than 18 years, had a primary diagnosis of HF, and were receiving care at an outpatient HF clinic in Los Angeles. Such patients were included in the study if they were alert and oriented and able to understand English.

Ninety-one patients expressed an interest in participating in the study and met the selection criteria, signed informed consent, and completed the

Results

The compliance rate for the overall HF regimen was 85.13% (SD, 10.01%). Higher levels of compliance (>90%) were noted for follow-up appointments, taking prescribed medications, and smoking and alcohol cessation. Poor compliance (<75%) was observed with dietary and exercise recommendations (Table II).

The mean scores on social support and psychosocial variables are also provided in Table II. On average, patients in the sample had a network of 5 persons who provided them with support. Perceived

Discussion

The overall compliance rate documented in this study was high. In general, patients were compliant with follow-up appointments, taking prescribed medications, and smoking and alcohol cessation. These scores are higher than the ones reported in the literature for the general population as compiled by Haynes,25 which were as follows: follow-up appointments, 16% to 84%; medications, 31% to 58%; and smoking cessation 71% to 96%. However, compliance rates with dietary and exercise recommendations

Conclusion

In this study, we found that patients with HF had poor compliance with dietary and exercise regimens. Since following a dietary and exercise regimen has been demonstrated to reduce morbidity in this population, strategies to increase compliance with diet and exercise recommendations should be rigorously pursued. Helping patients understand their treatment regimen may improve their compliance. In addition, interventions to promote self-management and increase perceptions of mental and physical

References (27)

  • M Weintraub

    Compliance in the elderly

    Clin Geriatr Med

    (1990)
  • W Kruse et al.

    Monitoring compliance in clinical trials

    Lancet

    (1990)
  • American Heart Association

    Hospital discharges for cardiovascular diseases. Biostatistical fact sheets, 1-3

    (1999)
  • National Heart, Lung and Blood Institute

    Congestive heart failure in the United States: a new epidemic. Congestive heart failure data fact Sheet, 1-6

    (1996)
  • EJ Graves

    National hospital discharge survey: annual summary 1993

    Vital Health Stat

    (1995)
  • American Heart Association

    Older Americans and cardiovascular diseases. Biostatistical fact sheets, 1-5

    (1999)
  • KKL Ho et al.

    The epidemiology of heart failure: the Framingham Study

    J Amer Coll Cardiol

    (1993)
  • MW Rich et al.

    Cost-effectiveness analysis in clinical practice: the case of heart failure

    Arch Intern Med

    (1999)
  • J O’Connell et al.

    Economic impact of heart failure in the United States: time for a different approach

    J Heart Lung Transplant

    (1994)
  • L Evangelista et al.

    A closer look at compliance research in heart failure patients in the last decade

    Prog Cardiovasc Nurs

    (2000)
  • LE Burke et al.

    Adherence to medication, diet, and activity recommendations: from assessment to maintenance

    J Cardiovasc Nurs

    (1995)
  • J Dunbar-Jacob

    Predictors of patient adherence: patient characteristics

  • CM Cline et al.

    Cost effective management programme for heart failure reduces hospitalisation

    Heart

    (1998)
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    *

    Funded by a Pre-doctoral Fellowship Award from the American Heart Association, Western States Affiliate.

    **

    Reprint requests: Lorraine S. Evangelista, RN, PhD, 23653 White Oak Ct, Santa Clarita, CA 91321.

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