Causes and Consequences of Nonpersistence With Heart Failure Medication
Causes and Consequences of Nonpersistence With Heart Failure Medication
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DOI：
10.1016/j.amjcard.2008.11.058
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发表时间：
2009-03-15
影响因子：
2.8
通讯作者：
Ledwidge, Mark Thomas
中科院分区：
文献类型：
--
作者：
Mockler, Mary;O'Loughlin, Christina;Ledwidge, Mark Thomas
与依从性相比，坚持治疗在临床环境中可能更容易和客观地确定，最近的研究表明，它与心力衰竭(HF)的死亡率有关。这项研究的目的是在一项对183名参加疾病管理计划的收缩期心衰患者进行的回顾性队列研究中，确定非持续性疾病调整治疗的程度、原因和临床影响。主要的结果测量是非持续性的原因/决定因素及其对住院的影响。53名患者(29%)在疾病修正治疗中有74次不同的持续时间。50%的病例没有停止服药的医学原因，而30%的病例因不良反应而停药，15%的病例因正当的医学原因而停药。非持续性是全原因再入院(危险比3.20，95%可信区间1.74-11.37)和心血管再入院(危险比4.45，95%可信区间1.74-11.37)的显著预测因子。在调整后的模型中，心力衰竭再入院的风险没有显著增加(危险比2.41，95%可信区间0.88到6.62)。总而言之，心力衰竭治疗的非持续性是常见的，通常没有医学上的合理性，而且与住院风险增加有关。(C)2009 Elsevier Inc.保留所有权利。(美国心脏杂志2009；103：834-838)
Persistence with therapy may be more easily and objectively identified in the clinical setting than compliance and recent work has shown it to be linked to mortality in heart failure (HF). The aim of this study was to determine the extent, causes, and clinical impact of nonpersistence with disease-modifying therapy in a retrospective cohort study of 183 patients with systolic HF participating in a disease management program. The main outcome measurements were reasons/determinants of nonpersistence and its impact on hospitalizations. Fifty-three patients (29%) had 74 separate occurrences of nonpersistence with disease-modifying therapy. There was no medical reason for discontinuing medications in 50% of occurrences, whereas medication was discontinued for an adverse reaction in 30% and for a justified medical reason in 15% of occurrences. Nonpersistence was a significant predictor of all-cause readmission (hazard ratio 3.20, 95% confidence interval 1.74 to 11.37) and cardiovascular readmission (hazard ratio 4.45, 95% confidence interval 1.74 to 11.37). In the adjusted model, there was no significantly increased risk of HF readmission (hazard ratio 2.41, 95% confidence interval 0.88 to 6.62). In conclusion, nonpersistence with HF therapy is common, is often not medically justified, and is associated with an increased risk of hospitalization. (C) 2009 Elsevier Inc. All rights reserved. (Am J Cardiol 2009;103:834-838)