Diuretic compliance, quality of life, and health care utilization in heart failure patients
Abstract
The purpose of the present study is to examine the relationships among medication compliance with diuretic therapy, health-related quality of life (HRQL) and disease outcomes in heart failure (HF) patients. The major research questions addressed were: (1) What is the relationship between medication compliance and HRQL? (2) What is the effect of medication compliance on hospitalizations and emergency department visits? (3) What is the cut-off point in medication compliance that can predict hospitalizations and emergency department visits? (4) What are the effects of demographic factors and severity of illness on medication compliance? HF patients at Wishard Memorial Hospital in Indianapolis, Indiana were contacted via a letter and then in person at their clinic visit. Upon enrollment, a six-month supply of their diuretic was provided to them in a bottle with an electronic monitor. At the same time, the Chronic Heart Failure Questionnaire was administered. The questionnaire was administered four additional times following enrollment. Health care utilization data for the six-month study period were obtained from the Wishard Hospital medical database. Forty-two patients completed the study. The sample was characterized as mostly single middle-aged patients with moderate HF. The average daily compliance and scheduled compliance were reported as 71.0% and 43.7%, respectively. Overall and dimensional scores on the Chronic Heart Failure Questionnaire indicated that study patients reported low to moderate HRQL. All study patients were hospitalized at least one time during the study period. Most patients also visited the emergency department once. No significant relationship was found between compliance variables and HRQL domains; however a correlation between daily compliance and emotional function approached significance, suggesting that greater emotional functioning may be related to lower medication compliance. Significant correlations were found between scheduled compliance and both cardiac-related hospital admissions and cardiac-related emergency department visits. This suggests that the time course delivery of diuretics may be an important factor in determining utilization. Furthermore, there was a significant difference in proportion of health care utilization in patients with at least 65% daily compliance. With the exception of education and age, demographic factors and severity of illness did not have any impact on medication compliance.
Degree
Ph.D.
Advisors
Mason, Purdue University.
Subject Area
Pharmaceuticals|Health care
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