Difficulty Taking Medications, Depression, and Health Status in Heart Failure Patients

doi:10.1016/j.cardfail.2005.08.004

Journal of Cardiac Failure

Volume 12, Issue 1, February 2006, Pages 54-60

https://doi.org/10.1016/j.cardfail.2005.08.004 Get rights and content

Abstract

Background

Little is known about medication nonadherence in heart failure populations. We evaluated the association between 1 aspect of medication nonadherence, patient-reported difficulty taking medications as directed, and health status among heart failure outpatients, and then examined whether this association was explained by depression.

Methods and Results

A total of 522 outpatients with left ventricular ejection fraction <0.40 completed clinical evaluation, Kansas City Cardiomyopathy Questionnaire (KCCQ), Medical Outcomes Study-Depression questionnaire, and categorized their difficulty taking medications (5-level Likert-scale question). Multivariable regression was used to evaluate the cross-sectional association between difficulty taking medications and health status, with incremental adjustment for medical history and depressive symptoms. Patients with difficulty taking medications (n = 64; 12.2%) had worse health status (8.2 ± 2.7 point lower mean KCCQ summary scores; P = .008) and more depressive symptoms (43.8% versus 27.1%; P = .006). Adjusting for demographic and clinical factors had little effect on the association between difficulty taking medications and health status (8.0 ± 3.2 point lower KCCQ scores; P = .01); however, the relationship was attenuated with adjustment for depressive symptoms (4.7 ± 2.9 point lower KCCQ scores; P = .11).

Conclusions

Among heart failure outpatients, difficulty taking medications is associated with worse health status. This association appears to be explained, in part, by coexistent depression. Future studies should evaluate interventions such as depression treatment to improve medication adherence and health status.

Section snippets

Study Population

Patients were recruited through the Cardiovascular Outcomes Research Consortium, a collaborative of investigators from 14 North American centers (Appendix). Outpatients with the diagnosis of heart failure in their medical record or a hospitalization for decompensated heart failure within 3 years were screened for participation. Patients with documented left ventricular ejection fraction <0.40 and who were older than 30 years of age were asked to participate and to provide informed consent.

Study Population

Of the 522 patients, 64 (12.2%) reported difficulty taking their medications. Patients with difficulty taking medications were less likely to be male, less likely to be white, and were younger than patients without difficulty taking their medications (Table 1). The 2 groups were similar with regard to left ventricular ejection fraction, etiology of heart failure, noncardiac factors, and medication regimens with the exception of digoxin use, which was more frequently prescribed among patients

Discussion

The objectives of this study were to evaluate the association between patient-reported difficulty taking medications as directed and health status among heart failure outpatients, and then to examine whether this association was explained by depression. We found that patients who reported difficulty taking their medications had significantly worse heart failure–related health status than patients without difficulty taking medications, independent of other demographic and clinical

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Cited by (92)

Depression Subtypes in Systolic Heart Failure: A Secondary Analysis From a Randomized Controlled Trial
2023, Journal of the Academy of Consultation-Liaison Psychiatry
Heart failure (HF) is associated with an elevated risk of morbidity, mortality, hospitalization, and impaired quality of life. One potential contributor to these poor outcomes is depression. Yet the effectiveness of treatments for depression in patients with HF is mixed, perhaps due to the heterogeneity of depression.
This secondary analysis applied latent class analysis (LCA) to data from a clinical trial to classify patients with systolic HF and comorbid depression into LCA subtypes based on depression symptom severity, and then examined whether these subtypes predicted treatment response and mental and physical health outcomes at 12 months follow-up.
In LCA of 629 participants (mean age 63.6 ± 12.9; 43% females), we identified 4 depression subtypes: mild (prevalence 53%), moderate (30%), moderately severe (12%), and severe (5%). The mild subtype was characterized primarily by somatic symptoms of depression (e.g., energy loss, sleep disturbance, poor appetite), while the remaining LCA subtypes additionally included nonsomatic symptoms of depression (e.g., depressed mood, anhedonia, worthlessness). At 12 months, LCA subtypes with more severe depressive symptoms reported significantly greater improvements in mental quality of life and depressive symptoms compared to the LCA mild subtype, but the incidence of cardiovascular- and noncardiovascular-related readmissions, and mortality was similar among all subtypes.
In patients with depression and systolic heart failure those with the LCA mild depression subtype may not meet full criteria for major depressive disorder, given the overlap between HF and somatic symptoms of depression. We recommend requiring depressed mood or anhedonia as a necessary symptom for major depressive disorder in patients with HF.
Trends in and predictors of multiple readmissions following heart failure hospitalization: A National wide analysis from the United States
2023, American Journal of the Medical Sciences
Citation Excerpt :
While some studies did not identify age as an independent predictor of readmissions, 31,32 others report higher rates of readmissions in younger patients.33 Potential reasons for this association could be more aggressive disease, increased prevalence of HF with reduced ejection fraction, non-compliance, lack of insurance and other comorbidities such as substance use and psychiatric illness among young patients.33–36 In agreement with these prior reports, patients with multiple readmissions had higher prevalence of substance use (5.5%, compared to 3% in single readmission) and depression (11.9% vs 11.1% in single readmission group) though the proportion of uninsured patients was similar in both groups (1.8% vs 1.9).
Readmission following Heart failure (HF) hospitalization is common: 25% are readmitted within a month of discharge and ≈50% within 6 months. A small proportion of these patients can have multiple readmissions within this period, adding disproportionately to the health care costs. In this study, we assessed the trends, predictors and costs associated with multiple readmissions using National readmissions database (NRD).
We queried NRD for HF hospitalizations from 2010 to 2018 using ICD-9/10-CM codes. Multinomial logistic regression was used to compare readmission cohorts, with the multivariable model adjusting for other factors. All analyses accounted for the NRD sampling design were conducted using SAS v. 9.4 with p < 0.05 used to indicate statistical significance.
Within the study period, an estimated 6,763,201 HF hospitalizations were identified. Of these, 58% had no readmission; 26% had 1 readmission; and 16% had ≥2 readmissions within 90 days of index hospitalization. There was no statistically significant change in readmission rates during the observation period. Multiple readmissions which accounted for 37% of all readmissions contributed to 57% of readmission costs. Younger age was identified as a predictor of multiple readmissions while sex, comorbidities and the type of insurance were not significantly different from those with single readmission.
Multiple readmissions in HF are common (16%), have remained unchanged between 2010 and 2018 and impose a significant health care cost burden. Future research should focus on identifying these patients for targeted intervention that may minimize excessive readmissions particularly in those patients who are in the palliation phase of HF.
Psychological Disorders in Heart Failure
2022, Cardiology Clinics
10-Year trend in the prevalence and predictors of depression among patients with heart failure in the USA from 2007–2016
2020, International Journal of Cardiology
Heart failure (HF) constitutes a major public health problem in the USA with self-management playing a key role in treatment. Depressed patients often have poor insights which correlates with increased rates of adverse events such as emergency room visits, admissions and readmissions, length of hospital stay and mortality.
To determine the prevalence, trends, and predictors of depression among community-based patients with HF in the USA, and its association with self-perceived health status.
Using the 2007 through 2016 NHANES data, we identified patients with HF aged 20–80 years with completed PHQ-9 depression screening questionnaire. PHQ-9 scores ≥10 were considered diagnostic for depression. The Chi square test was used for comparison of prevalence of depression between subgroups with p < 0.05 considered statistically significant.
The prevalence of depression among community-based patients with HF was 17.3% and remained stable from 2007 through 2016. Female participants, persons <60years, individuals with low socioeconomic status, and never married individuals were more likely to be depressed, comparatively. After controlling for confounders, living in poverty was the lone predictor of depression with OR 5.1 (95% CI 1.4–17.9), compared to those with incomes ≥3 times the poverty threshold. Depressed individuals were more likely to report a poor health status (76.4%) compared to non-depressed individuals (45.9%), p < 0.001.
Over 1 in 6 community-based patients with HF suffers from depression with women, individuals <60years, never married, and persons with low socioeconomic status shouldering a disproportionately higher burden.
Psychological Disorders in Heart Failure
2020, Heart Failure Clinics
Editorial commentary: Re-inventing chronic disease management as a service – Medication adherence solutions are ground zero
2019, Trends in Cardiovascular Medicine

View all citing articles on Scopus

: Funding for the KCCQ Study was provided by Pharmacia, Inc. Dr. Rumsfeld is supported by a VA Health Services Research Advanced Career Development Award (RCD 98341-2). Dr. Masoudi is supported by a NIA Career Development Award (KO8-AG01011).

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Clinical InvestigationDifficulty Taking Medications, Depression, and Health Status in Heart Failure Patients

Abstract

Background

Methods and Results

Conclusions

Section snippets

Study Population

Study Population

Discussion

J Am Coll Cardiol

Lancet

J Psychosomatic Res

J Am Coll Cardiol

J Am Coll Cardiol

J Am Coll Cardiol

Lancet

J Card Failure

J Psychosom Res

Heart Disease and Stroke Statistics—2005 Update

Health-related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables

Heart

Health-related quality of life and psychological well being in patients with dilated cardiomyopathy

Heart

The relationship of treatment adherence to the risk of death after myocardial infarction in women

JAMA

Precipitating factors leading to decompensation of heart failure

Arch Intern Med

Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence

Arch Intern Med

Clinical Investigation
Difficulty Taking Medications, Depression, and Health Status in Heart Failure Patients