摘要
Background: Patients with heart failure(HF)face challenges complying with multidrug regimens. Objectives: To examine the impact of a compliance enhancing intervention on medication compliance and morbidity in HF. Design: Patients were randomized to either usual care or an inhospital educational intervention delivered by a multidisciplinary team(Intervention). Setting: Acute medical and surgical units at a teaching hospital. Patients: One hundred thirty four patients with a clinical diagnosis of HF and a left ventricular ejection fraction of< 40% requiring long-term medical treatment. Main Outcome Measures: A validated HF-specific instrument provided a measure of knowledge. We characterized patients as noncompliant if pharmacy refill data suggested they had taken ≤ 0.80 of their medication. We measured quality of life using the Minnesota Living with Heart Failure Questionnaire and the Short Form 36 and conducted a time to first event analysis of a composite end point including mortality, readmissions, and emergency department visits. Results: The Intervention group showed higher knowledge scores at discharge and 1 year(P=.05). The risk of noncompliance in Intervention patients varied from 0.78(95% CI 0.33- 1.89)for ACE-I(13% Intervention, 17% Control) to 1.02(0.49- 2.12)for diuretics(23% Intervention, 23% Control). Quality of life improved in both groups over time; the only difference between groups favored the Intervention(Minnesota Living with Heart Failure Questionnaire, P=.04). The composite end point occurred in 67% of control and 60% of Intervention patients(hazard ratio 0.85, 95% CI 0.55- 1.30). Conclusions: An inhospital educational intervention improved knowledge and, possibly, quality of life and may be useful as part of a comprehensive compliance enhancing strategy in patients with HF.
Background： Patients with heart failure（HF） face challenges complying with muhidrug regimens. Objectives： To examine the impact of a compliance enhancing intervention on medication compliance and morbidity in HF. Design： Patients were randomized to either usual care or an inhospital educational intervention delivered by a multidiseiplinary team（Intervention） . Setting： Acute medical and surgical units at a teaching hospital. Patients： One hundred thirty four patients with a clinical diagnosis of HF and a left ventricular ejection fraction of 〈 40% requiring long-term medical treatment. Main Outcome Measures： A validated HF-specific instrument provided a measure of knowledge. We characterized patients as noncompliant if pharmacy refill data suggested they had taken ≤ 0. 80 of their medication. We measured quality of life using the Minnesota Living with Heart Failure Questionnaire and the Short Form 36 and conducted a time to first event analysis of a composite end point including mortality, readmissions, and emergency department visits.
