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Heart Lung. 2012 Mar-Apr;41(2):107-14. doi: 10.1016/j.hrtlng.2011.09.009. Epub 2011 Nov 3.

Medication adherence mediates the relationship between marital status and cardiac event-free survival in patients with heart failure.

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  • 1University of North Carolina at Chapel Hill, School of Nursing, Chapel Hill, North Carolina 27599-7460, USA. jiarongw@email.unc.edu

Abstract

OBJECTIVE:

Prognosis is worse in unmarried patients compared with married patients with heart failure (HF). The reasons for differences in outcomes are unclear, but variations in medication adherence may play a role, because medication adherence is essential to achieving better outcomes. The study objective was to determine whether medication adherence mediated the relationship between marital status and cardiac event-free survival in patients with HF.

METHODS:

Demographic, clinical, and psychosocial data were collected by questionnaires and medical record review for 136 patients with HF (aged 61 ± 11 years, 70% were male, 60% were in New York Heart Association class III/IV). Medication adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Cardiac event-free survival data were obtained by patient/family interview, hospital database, and death certificate review. A series of regression and Cox survival analyses were performed to determine whether medication adherence mediated the relationship between marital status and event-free survival.

RESULTS:

Cardiac event-free survival was worse in unmarried patients than in married patients. Unmarried patients were more likely to be nonadherent and 2 times more likely to experience an event than married patients (P = .017). Marital status was not a significant predictor of event-free survival after entering medication adherence in the model, demonstrating a mediation effect of adherence on the relationship of marital status to survival.

CONCLUSION:

Medication adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase medication adherence that take into account subgroups, such as unmarried patients, who are at higher risk for nonadherence.

Copyright © 2012 Elsevier Inc. All rights reserved.

PMID:
22054720
[PubMed - indexed for MEDLINE]
PMCID:
PMC3288268
Free PMC Article
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