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

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

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.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Cardiovascular Agents / therapeutic use*
  • Disease-Free Survival
  • Female
  • Follow-Up Studies
  • Heart Failure / drug therapy*
  • Heart Failure / psychology
  • Humans
  • Male
  • Marital Status*
  • Medication Adherence / psychology*
  • Middle Aged
  • Prognosis
  • Prospective Studies
  • Psychometrics / methods
  • Surveys and Questionnaires

Substances

  • Cardiovascular Agents