Factors Associated With Exacerbation of Heart Failure Include Treatment Adherence and Health Literacy Skills

• Published in: Clinical pharmacology and therapeutics Vol. 85; no. 6; pp. 651 - 658
• Main Authors: Murray, MD, Tu, W, Wu, J, Morrow, D, Smith, F, Brater, DC
• Format: Journal Article
• Language: English
• Published: Basingstoke Nature Publishing Group 01-06-2009
• Subjects: Aged; Biological and medical sciences; Cardiology. Vascular system; Cohort Studies; Emergency Service, Hospital - statistics & numerical data; Female; Heart; Heart Failure - drug therapy; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Hematocrit; Hospitalization - statistics & numerical data; Humans; Insurance Claim Review - statistics & numerical data; Male; Medical Assistance; Medical sciences; Medication Adherence; Middle Aged; Patient Education as Topic; Pharmacology. Drug treatments; Sodium - blood; Stroke Volume; Human; Heart failure; Exacerbation; Health; Heart disease; Risk factor; Cardiovascular disease; Treatment compliance; Vocational aptitude
• ISSN: 0009-9236; 1532-6535
• DOI: 10.1038/clpt.2009.7

We determined the factors associated with exacerbation of heart failure, using a cohort (n = 192) nested within a randomized trial at a university‐affiliated ambulatory practice. Factors associated with emergency or hospital care included left ventricular ejection fraction, hematocrit and serum sodium levels, refill adherence, and the ability to read a prescription label. Refill adherence of <40% was associated with a threefold higher incidence of hospitalization for heart failure than a refill adherence of ≥80% (P = 0.002). In multivariable analysis, prescription label reading skills were associated with a lower incidence of heart failure–specific emergency care (incidence rate ratio, 0.76; 95% confidence interval (CI), 0.19–0.69), and participants with adequate health literacy had a lower risk of hospitalization for heart failure (incidence rate ratio, 0.34; 95% CI, 0.15–0.76). We conclude that inadequate treatment adherence and health literacy skills are key factors in the exacerbation of heart failure. These findings emphasize the need for careful instruction of patients about their medications.
Clinical Pharmacology & Therapeutics (2009); 85, 6, 651–658 doi:10.1038/clpt.2009.7