Predictors of medication nonadherence differ among black and white patients with heart failure
Predictors of medication nonadherence differ among black and white patients with heart failure
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DOI：
10.1002/nur.21663
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发表时间：
2015-08-01
影响因子：
2
通讯作者：
Riegel, Barbara
中科院分区：
文献类型：
--
作者：
Dickson, Victoria Vaughan;Knafl, George J.;Riegel, Barbara
心力衰竭（HF）是一个全球性的公共卫生问题，结果仍然很差，特别是在少数民族人群中。药物依从性可以改善心力衰竭的结局，但众所周知的是低。对来自心力衰竭成人前瞻性队列比较研究的数据进行二次分析的目的是在212名心力衰竭成人中按种族组（黑人vs.白色）探索药物不依从性预测因素的差异。采用自适应建模分析方法分别对黑人（31.7%）和白色（68.3%）参与者的HF患者用药不依从性进行建模，以研究这两个种族组之间的差异。在63名黑人参与者中，33.3%的人的药物依从性较低，而149名白色参与者中的这一比例为27.5%。在黑人中，16个风险因素与双变量分析中的依从性相关;其中4个（更多的合并症，较低的血清钠，较高的收缩压，以及使用较少的活动补偿健忘）共同预测不依从性。在多危险因素模型中，黑人患者的危险因素数量从0到4不等，76.2%的患者至少有一个危险因素。每增加一个危险因素，用药不依从的估计比值比增加9.34倍。在白色参与者中，五个风险因素与双变量分析中的依从性相关;其中一个（年龄较大）解释了其他四个的个体效应。由于黑人HF患者与白人相比具有不同且更多的风险因素，因此需要采取干预措施来解决黑人HF患者的独特风险因素。(c)2015年威利期刊公司
Heart failure (HF) is a global public health problem, and outcomes remain poor, especially among ethnic minority populations. Medication adherence can improve heart failure outcomes but is notoriously low. The purpose of this secondary analysis of data from a prospective cohort comparison study of adults with heart failure was to explore differences in predictors of medication nonadherence by racial group (Black vs. White) in 212 adults with heart failure. Adaptive modeling analytic methods were used to model HF patient medication nonadherence separately for Black (31.7%) and White (68.3%) participants in order to investigate differences between these two racial groups. Of the 63 Black participants, 33.3% had low medication adherence, compared to 27.5% of the 149 White participants. Among Blacks, 16 risk factors were related to adherence in bivariate analyses; four of these (more comorbidities, lower serum sodium, higher systolic blood pressure, and use of fewer activities compensating for forgetfulness) jointly predicted nonadherence. In the multiple risk factor model, the number of risk factors in Black patients ranged from 0 to 4, and 76.2% had at least one risk factor. The estimated odds ratio for medication nonadherence was increased 9.34 times with each additional risk factor. Among White participants, five risk factors were related to adherence in bivariate analyses; one of these (older age) explained the individual effects of the other four. Because Blacks with HF have different and more risk factors than Whites for low medication adherence, interventions are needed that address unique risk factors among Black patients with HF. (c) 2015 Wiley Periodicals, Inc.