The Role of Depression on Treatment Adherence in Patients with Heart Failure-a Systematic Review of the Literature

Frailty determinants in heart failure: Inflammatory markers, cognitive impairment and psychosocial interaction

AIMS

This study aimed to identify factors associated with frailty in heart failure (HF) patients, focusing on demographic, biochemical and health-related variables. It also explored the correlation between frailty and comorbidities such as malnutrition, cognitive impairment and depression, assessing how these factors interact to influence frailty risk.

METHODS

A total of 250 HF patients (mean age 73.5 ± 7.2 years; 45.6% female) hospitalized for acute decompensated HF were included. Frailty was assessed using Fried phenotype criteria. Cognitive function, depression and nutritional status were evaluated using validated instruments [Mini-Mental State Examination (MMSE), Patient Health Questionnaire-9 (PHQ-9) and Mini Nutritional Assessment (MNA)]. Biochemical markers included C-reactive protein (CRP), N-terminal prohormone of brain natriuretic peptide (NT-proBNP), haemoglobin, estimated glomerular filtration rate (eGFR) and systolic blood pressure (SBP). Statistical analyses, including logistic regression, were performed to assess associations and odds ratios (ORs) for frailty, adjusted for inflammation and HF type.

RESULTS

Frailty was present in 60.4% of patients. Frail individuals exhibited significantly higher CRP (median 4.60 vs. 2.54 mg/L, P < 0.001) and NT-proBNP (median 2558.8 vs. 1102.6 pg/mL, P = 0.001) and lower haemoglobin (13.7 vs. 14.3 g/dL, P = 0.012), eGFR (62 vs. 71 mL/min/1.73 m2, P = 0.025) and SBP (130 vs. 134 mmHg, P = 0.026). Each 10% increase in CRP was associated with a 5.5% increase in frailty odds (P < 0.001). Frailty was linked to cognitive impairment (OR 2.1, P = 0.018), malnutrition (OR 3.0, P < 0.001) and depression (OR 3.1, P < 0.001), while high adherence to treatment reduced frailty risk by 78.9% (P = 0.027). Interactions were observed between cognitive impairment and body mass index (BMI) (P = 0.020), where higher BMI mitigated the frailty odds difference between cognitively impaired and unimpaired patients. Depression's association with frailty odds varied by adherence levels (P = 0.034) and central obesity (P = 0.047), with the absence of depression offering protection against frailty in patients with central obesity. These interactions remained significant after adjustment for HF type and left ventricular ejection fraction (LVEF) and were consistent across stratifications by these factors.

CONCLUSIONS

Frailty in HF is influenced by inflammatory markers, cognitive impairment and psychosocial factors. Elevated CRP and NT-proBNP were strong predictors of frailty. Cognitive impairment and depression were key modifiable factors, interacting with BMI, adherence and obesity. Targeting these factors with early interventions could mitigate frailty risk, improving outcomes and quality of life in HF patients.

Frailty and Self-Care Maintenance Mediated by Social Support and Depression in Older Adults With Heart Failure

BACKGROUND

Older adults with heart failure often exhibit poor self-care maintenance. Frailty could exacerbate self-care, leading to deteriorating health. Social support and depression may play a role in self-care maintenance in older adults with heart failure combined with frailty. Confirming this potential mechanistic relationship could provide valuable reference for nurses to formulate and improve the targeted intervention strategies and health education programs for older adults with heart failure.

OBJECTIVES

This study analyzed the relationship between frailty and self-care maintenance in older adults with heart failure and determined the sequential mediation effect of social support and depression. Its goal was to provide valuable theoretical insights for formulating targeted clinical nursing interventions for older adults with heart failure.

METHODS

A cross-sectional study was conducted from July 2023 to February 2024, during which older adults with heart failure were recruited using a convenience sampling method from the cardiovascular department of a tertiary Class A hospital in Qingdao, China. A total of 241 completed the Tilburg Frailty Indicator, the Self-Care of Heart Failure Index, the Social Support Rating Scale, and the Patient Health Questionnaire-9. t -Tests and one-way analysis of variance were used to examine differences in self-care maintenance among participants with distinct characteristics; correlation analysis was used to identify variable relationships within the study. The mediation model was tested using the SPSS PROCESS macro and the bootstrap method.

RESULTS

Frailty was negatively correlated with self-care maintenance, and both social support and depression were significantly related to frailty and self-care maintenance. Social support and depression not only independently mediated the relationship between frailty and self-care maintenance but also exhibited a significant sequential mediation effect.

DISCUSSION

The frailty of older adults with heart failure and its correlation with self-care maintenance is a complex and multidimensional phenomenon. Frailty not only directly influenced self-care maintenance in participants but also indirectly affected it through the mediating factors of social support and depression. Future research should emphasize innovative, targeted interventions to enhance social support quality and accessibility and alleviate depression, ultimately boosting patients' self-care capabilities and elevating their quality of life.

Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses

INTRODUCTION

Depression and anxiety are prevalent psychological disorders that significantly affect physical, emotional, and social well-being, reducing quality of life and increasing medical costs. These issues are especially challenging for cancer survivors, complicating treatment management, affecting adherence, and potentially impacting survival rates. Thus, this umbrella review aimed to evaluate the global prevalence of pain, depression, and anxiety, as well as their determinants among cancer patients.

METHOD

An exhaustive umbrella review was conducted to systematically assess the prevalence and determinants of pain, depression, and anxiety among cancer survivors worldwide by analyzing systematic reviews and meta-analyses. The review involved a thorough search of multiple databases and included studies published in English up to July 2024 that reported on these symptoms. The process involved screening and selecting studies based on specific criteria, assessing the risk of bias using the AMSTAR tool, and analyzing data with statistical methods to determine overall prevalence and identify predictors. This comprehensive approach aimed to provide a detailed understanding of these psychological issues in cancer survivors and guide future research and interventions.

RESULT

The global summary prevalence of depression among cancer survivors was 33.16% (95% CI 27.59-38.74), while anxiety had a prevalence of 30.55% (95% CI 24.04-37.06). Pain prevalence after treatment was 39.77% (95% CI 31.84-47.70). Before treatment, 65.22% (95% CI 62.86-67.57) of cancer patients reported pain, which persisted in 51.34% (95% CI 40.01-62.67) during treatment. The analysis also found that during the COVID-19 pandemic, depression and anxiety rates among cancer patients were at their highest, with prevalences of 43.25% (95% CI 41.25-45.26) and 52.93% (95% CI 50.91-54.96), respectively.

CONCLUSION

The umbrella review found that depression and anxiety prevalence among cancer survivors was 33.16% and 30.55%, respectively, with significantly higher rates during COVID-19 at 43.25% and 52.93%. Key factors contributing to depression included poor social support, advanced cancer stage, and inadequate sleep, while anxiety was significantly linked to advanced cancer stage and poor sleep quality.

CLINICAL TRIAL NUMBER

Not applicable.

Self-Efficacy, Social Support, and Depression: Mediators of Medication Adherence in Dialysis Patients

Introduction: Healthcare providers' understanding of how self-efficacy and social support affect medication adherence and depression in dialysis patients can lead to holistic interventions and improve outcomes. This study aimed to investigate how self-efficacy and social support indirectly influence the relationship between medication adherence and depressive symptoms in patients with chronic kidney disease (CKD) undergoing dialysis. Methods: We employed a cross-sectional observational study design with 668 CKD patients from outpatient departments (OPDs) and dialysis centers in the Hail region of Saudi Arabia. The data were collected between April and May 2024. Results: The participants had a relatively high level of self-efficacy (median = 82.00/100) and greater perception of social support (median = 75.500/84) with minimal to mild depressive symptoms (median = 15.00/63); however, 50% of participants scored ≥ 5 (out of 10) on the level of adherence to their medication regimen. Depression was prevalent, with a mean score of 5.03 on the PHQ-9 scale, and was positively correlated with nonadherence. Social support and self-efficacy were negatively correlated with depression, and both partially mediated the link between depression and non-adherence. Conclusions: This study found that, despite high social support and self-efficacy, a significant number of patients with CKD on dialysis exhibited medication non-adherence. Depression has emerged as a key factor influencing adherence, even in the presence of social support and self-efficacy. These findings suggest that depression is crucial for CKD management. Healthcare providers, owing to their frequent interactions with patients with CKD, are ideally placed to screen for depression and incorporate management strategies into patient care plans. By addressing both the biological and psychological aspects of CKD, they can empower patients to take a more active role in their treatment, ultimately leading to improved health outcomes.

Interventions for increasing medication adherence in heart failure patients: A narrative review

Heart failure is one of the critical and most costly medical challenges of the 21st century. It is a chronic debilitating condition and adherence to medication, a precondition for successful treatment is often poor. There are various interventions for improving the adherence. Depending on the goal of the intervention, these are roughly patient centric, healthcare provider centric and system centric. We provide an overview of these interventions with a focus on effectiveness and appropriateness in different clinical situations. Their use can lead to improved patient outcomes and reduced economic burden of the disease.

Factors associated with medication non-adherence among patients with heart failure

OBJECTIVE

to identify the factors contributing to medication non-adherence among patients with heart failure.

METHOD

cross-sectional and analytical study using the Medida de Adesão ao Tratamento [Treatment Adherence Measure] scale to assess medication non-adherence. Independent variables were collected using the European Heart Failure Self-care Behavior Scale and an instrument developed by the authors based on a previous study. Statistical tests were implemented to analyze data with p≤0.05 statistical significance.

RESULTS

the sample comprised 340 patients, with 9.4% considered non-adherent. The multiple analysis results showed that one unit increase in an individual's self-care score led to an 8% increase in the prevalence of non-adherence; patients with a family income above three times the minimum wage presented a prevalence of non-adherence equal to 3.5% of the prevalence of those with up to one times the minimum wage; individuals consuming alcohol or with depression presented 3.49 and 3.69 times higher prevalence of non-adherence, respectively, than individuals not presenting such history.

CONCLUSION

medication non-adherence was associated with self-care, family income, depression, and alcohol consumption.

A meta-analysis of effectiveness of mobile health interventions on health-related outcomes in patients with heart failure

AIMS

To systematically evaluate the effectiveness of mobile health (mHealth) interventions on medication adherence in patients with heart failure.

METHODS

The literature search was conducted in PubMed, Web of Science, the Cochrane Library databases, Embase, China National Knowledge Infrastructure (CNKI), Wanfang Database and China Scientific Journal Database (VIP). The retrieval period was from the establishment of the database to May 2023. The included studies were trials to explore the effectiveness of mHealth interventions on medication adherence in patients with heart failure. Cochrane collaboration's tool was used for assessing risk of bias in randomized controlled trials. Stata 17.0 software was used to conduct data analysis. Continuous data were expressed as standard mean differences, and dichotomous data were expressed as relative risks with 95% confidence intervals (CIs).

RESULTS

A total of 13 studies and 2534 participants were included. One study was rated as Grade A, and the other 12 studies were Grade B. The results of meta-analysis indicate that mHealth interventions are effective in improving medication adherence [relative risk (RR) = 1.26, 95% CI 1.10-1.44, P < 0.05 and standard mean difference = 0.80, 95% CI 0.44-1.15, P < 0.05], and reducing readmission rates (RR = 0.63, 95% CI 0.53-0.76, P < 0.05) and mortality (RR = 0.63, 95% CI 0.43-0.94, P < 0.05) of patients with heart failure.

CONCLUSION

mHealth interventions are beneficial to improve medication adherence in patients with heart failure, and could effectively reduce the readmission rates and mortality of patients in the studies. There is a need to continuously improve the professional abilities of intervention personnel, carry out teamwork, and extend intervention and follow-up time. Convenient, fast and low-cost mobile medical devices should be adopted to reduce the cost of medical treatment. Scientific and reasonable intervention content will be formulated according to evidence-based guidelines and theoretical basis to enhance patients' ability at self-management and understanding of heart failure knowledge.

Impact of digital and conventional rehabilitation aftercare on physical and mental health in orthopedic patients in Germany

The integration of digital interventions in health rehabilitation offers promising opportunities to improve patient outcomes. However, empirical studies comparing the effectiveness of digital and traditional rehabilitation interventions remain scarce. This study was designed to evaluate the impact of a digital aftercare program, compared to traditional aftercare and a control group, on both psychological and physical health outcomes in individuals undergoing orthopedic rehabilitation. Additionally, the study also aimed to examine the moderating effects of age and gender. The study employed a partially controlled trial design, engaging a cohort of 805 orthopedic patients, divided into: digIRENA (n = 323, digital aftercare), IRENA (n = 252, traditional aftercare), and a control group (n = 230, without organized aftercare). Measurements took place at four different time points: baseline (start of the rehabilitation program), T1 (13 weeks after the start of rehabilitation, marking the midpoint of aftercare), T2 (26 weeks, marking the end of aftercare), and T3 (43 weeks, to assess the sustainability of aftercare effects). The SF-12 Health Survey was the primary data collection instrument for measuring trends in physical and mental health outcomes over these intervals using repeated measures ANOVA. The results show that rehabilitants in the digIRENA group participated for a longer period of time than rehabilitants in the IRENA group, while the two groups did not differ in terms of motivation at T0 and organized physical activity outside of aftercare at T3. A significant improvement in physical health outcomes was observed in all groups across time, with digIRENA participants showing the greatest improvement. For mental health, all groups showed initial improvements, with the digIRENA group showing the most pronounced increase at T2. Overall, there was a decline in the effects achieved 4 months after the end of aftercare. When age and gender were included as covariates, the time effect for mental health disappeared, showing a significant time * gender interaction due to significantly lower baseline scores of women compared to men. The results of the study show that digital interventions, in particular the digIRENA program, contribute to improving health rehabilitation outcomes. The digIRENA program and similar digital health interventions may offer potential for improving health rehabilitation aftercare.

Assessment of adherence to treatment recommendations among patients with heart failure: a cross-sectional study

BACKGROUND

Heart failure (HF) is a chronic condition characterized by significant impairment of the cardiovascular system, leading to a decline in health-related quality of life, recurrent hospitalizations, and increased mortality risk. It poses a substantial challenge for modern medicine, particularly when patients fail to adhere to therapeutic recommendations. The primary aim of this study was to evaluate the level of adherence to therapeutic guidelines among patients with HF and identify factors influencing adherence levels.

METHODS

The study comprised 105 HF patients admitted to the cardiology department. A diagnostic survey approach was utilized, employing the Adherence in Chronic Diseases Scale (ACDS) along with a self-developed questionnaire.

RESULTS

The findings revealed that 39.05% of participants exhibited a moderate level of adherence to therapeutic recommendations, while 34.29% reported high adherence and 26.67% displayed low adherence. Most of the patients (n = 66) had a rather good level of knowledge. Factors such as higher education (p < 0.001), engagement in mental work (p = 0.001), favorable socioeconomic status (p < 0.001), being in a stable relationship (p < 0.001), and residing with family (p < 0.001) were associated with increased adherence levels. The multivariable linear regression model indicated significant (p < 0.05) independent predictors that positively influenced the ACDS score, including being in a relationship, widowhood, and average or poor financial situation. Conversely, factors such as obesity and respiratory diseases were associated with a decrease in the ACDS score (p < 0.05).

CONCLUSIONS

This study underscores the moderate adherence level to therapeutic recommendations among HF patients. Sociodemographic factors including education level, relationship status, occupation, financial stability, and living arrangements significantly impact adherence. Conversely, patients with obesity, respiratory conditions, or frequent HF-related hospitalizations demonstrate lower adherence. Patient education emerges as a pivotal factor influencing adherence. Tailored interventions targeting these factors could enhance adherence and optimize HF management outcomes.

Psychosocial predictors of health behavior adherence in heart-failure patients with comorbid depression: a secondary analysis of the Hopeful Heart trial

BACKGROUND

Depression affects 20-30% of individuals with heart failure (HF), and it is associated with worse health outcomes independent of disease severity. One potential explanation is the adverse impact of depression on HF patients' adherence to the health behaviors needed to self-manage their condition. The aim of this study is to identify characteristics associated with lower adherence in this population, which could help to recognize individuals at higher risk and eventually tailor health behavior interventions to their needs.

METHODS

Using data from a randomized, controlled, collaborative care treatment trial in 629 patients with HF and comorbid depression, we performed mixed effects logistic regression analyses to examine the cross-sectional and prospective relationships between medical and psychosocial variables and health behavior adherence, including adherence to medications, a low-sodium diet, and physician appointments.

RESULTS

In cross-sectional analyses, married marital status and higher physical health-related quality of life (HRQoL) were associated with greater overall adherence (compared to married, single Odds Ratio [OR] = 0.46, 95% Confidence Interval [CI] = 0.26-0.80; other OR = 0.60, CI = 0.38-0.94; p = .012. Physical HRQoL OR = 1.02, CI = 1.00-1.04, p = .047). Prospectively, greater levels of social support were associated with improved overall adherence one year later (OR = 1.04, 95% CI = 1.00-1.08, p = .037). Social support, HF symptom severity, race and ethnicity, and age were predictors of specific types of adherence. Neither depression nor optimism was significantly associated with adherence outcomes.

CONCLUSIONS

These results provide important preliminary information about risk factors for poor adherence in patients with both HF and depression, which could, in turn, contribute to the development of interventions to promote adherence in this high-risk population.

TRIAL REGISTRATION

https://clinicaltrials.gov/ct2/show/NCT02044211 ; registered 1/21/2014.

Evaluation of adherence to pharmacological treatments by undocumented migrants with chronic diseases: a 10-year retrospective cohort study

OBJECTIVES

To investigate the time course of medication adherence and some of the factors involved in this process in undocumented migrants with chronic diseases.

DESIGN

Retrospective cohort study.

SETTING

A big non-governmental organisation in Milano, Italy, giving medical assistance to undocumented migrants.

PARTICIPANTS

1918 patients, 998 females and 920 males, with at least one chronic condition (diabetes, cardiovascular diseases (CVDs), mental health disorders) seen over a period of 10 years (2011-2020). Their mean age was 49.2±13 years.

RESULTS

Adherence to medications decreased over 1 year in all patients. This was more evident during the first 2 months of treatment. Patients on only one medication were less adherent than those on more than one medication; at 6 months the percentage of patients with high adherence was 33% vs 57% (p<0.0001) for diabetes, 15% vs 46% (p<0.0001) for mental disorders and 35% vs 59% (p<0.0001) for CVDs. Patients with mental disorders had the lowest adherence: 25% at 6 months and 3% at 1 year. Mental disorders, when present as comorbidities, greatly reduced the probability of being highly adherent: risk ratio (RR) 0.72 (95% CI 0.57 to 0.91; p=0.006) at 3 months, RR 0.77, (95% CI 0.59 to 1.01; p=0.06) at 6 months, RR 0.35 (95% CI 0.13 to 0.94; p=0.04) at 1 year. This was especially evident for patients with CVDs, whose percentage of high adherents decreased to 30% (p=0.0008) at 6 months and to 3% (p=0.01) at 1 year. We also noted that highly adherent patients usually were those most frequently seen by a doctor.

CONCLUSIONS

Interventions to increase medication adherence of undocumented migrants with chronic diseases are necessary, particularly in the first 2 months after beginning treatment. These should be aimed at people-centred care and include more outpatient consultations. Educational interventions should especially be taken into consideration for patients on monotherapy.

Factors influencing adherence to non-communicable disease medication in India: secondary analysis of cross-sectional data from WHO - SAGE2

Background: Non-communicable diseases (NCDs) are a leading cause of death globally and disproportionately affect those in low- and middle-income countries lower-middle-income countries. Poor medication adherence among patients with NCDs is prevalent in India due to lack of initiation, missed dosing or cessation of treatment, and represents a growing healthcare and financial burden. Objective: This study aimed to identify factors influencing medication adherence in adults with NCDs in India. Methods: We performed a cross-sectional study, conducting secondary data analysis on the second wave of the World Health Organisation's 'Study on global AGEing and adult health (SAGE)', a survey that collected data from predominantly older adults across India. Bivariate analysis and multivariate logistic regression modelling were conducted to specifically interrogate the reasons for lack of initiation and cessation of treatment. Reporting of this study was informed by the STROBE guidelines. Results: The average medication adherence rate was 51% across 2,840 patients with one or more NCDs, reflecting non-initiation and lack of persistence of treatment. The strongest factor significantly predicting non-adherence to medication across these components was multimorbidity (odds ratio 0.47, 95% CI 0.40-0.56). Tobacco use (OR = 0.76, CI 0.59-0.98) and never having attended school (OR = 0.75, CI 0.62-0.92) were significantly associated with poor medication adherence (p < 0.05) while rural living (OR = 0.70, CI 0.48-1.02), feelings of anxiety (OR = 0.84, CI 0.66-1.08) and feelings of depression (OR = 0.90, CI 0.70-1.16) were factors lacking statistically significant association with medication adherence on multivariate analysis. Older age (OR = 2.02, CI 1.51-2.71) was significantly associated with improved medication adherence whilst there was a weak association between increased wealth and improved medication use. Limitations: The SAGE2 survey did not capture whether patients were taking their medication doses according to prescribed instructions-as a result our findings may under-estimate the true prevalence of medication non-adherence. Conclusion: Our analysis provides evidence that poor medication adherence in India is multifactorial, with distinct socioeconomic and health-system factors interacting to influence patient decision making. Future large-scale surveys interrogating adherence should assess all components of adherence specifically, whilst public health interventions to improve medication adherence should focus on barriers that may exist due to multimorbidity, comorbid depression and anxiety, and low educational status.