Precipitating factors of decompensation of heart failure related to treatment adherence: multicenter study-EMBRACE

Rabelo-Silva, Eneida Rejane; Saffi, Marco Aurélio Lumertz; Aliti, Graziella Badin; Feijó, Maria Karolina; Linch, Graciele Fernanda da Costa; Sauer, Jaquelini Messer; Martins, Silvia Marinho

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Revista Gaúcha de Enfermagem

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Original Article • Rev. Gaúcha Enferm. 39 • 2018 • https://doi.org/10.1590/1983-1447.2018.20170292 copy

Precipitating factors of decompensation of heart failure related to treatment adherence: multicenter study-EMBRACE

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE

To describe the precipitating factors of heart failure decompensation between adherent and non-adherent patients to treatment.

METHODS

Cross-sectional study of a multicenter cohort study. Patients over 18 years of age with decompensated heart failure (functional class III/IV) were eligible. The structured questionnaire was used to collect the data and evaluate the reasons for decompensation. The irregular use of medication prior to hospitalization and inadequate salt and fluid intake were considered as poor adherence to treatment.

RESULTS

A total of 556 patients were included, mean age 61 ± 14 years old, 362 (65%) male. The main factor of decompensation was poor adherence, representing 55% of the sample. Patients who reported irregular use of medications in the last week had a 22% greater risk of being hospitalized due to poor adherence than the patients who adhered to treatment.

CONCLUSION

The EMBRACE study showed that in patients with heart failure, poor adherence was the main factor of exacerbation.

Keywords:
Heart failure; Multicenter study; Precipitating factors

Variable	Poor adherence n = 307	Other causes n = 249	P value
Age, years^* * Mean ± standard deviation;	61.4±13.9	60.9±14.7	0.164
Sex, male^† † n (%)	211(68.7)	151(60.6)	0.047
Does not live alone^† † n (%)	265(86.3)	221(89.1)	0.321
Schooling, years^‡ ‡ median (25-75 percentile);	5(2-8)	5(1-8)	0.169
Ethnicity/Race, white^† † n (%)	220(71.7)	151(60.6)	0.002
Etiology, ischemic^† † n (%)	100(32.6)	104(41.8)	0.023
Etiology, hypertensive^† † n (%)	100 (32.6)	76(30.5)	0.668
Etiology, valvar^† † n (%)	22(7.2)	30(12)	0.202
Etiology, Chagas^† † n (%)	16(5.2)	15 (6)	0.643
LV ejection fraction (%)^* * Mean ± standard deviation;	28.8±7.9	29.4±8.1	0.628
Functional class^† † n (%)
III	163(53.3)	144(58.8)	0.196
IV	143(46.7)	101(41.2)	0.196
Creatinine (mg/dL)^‡ ‡ median (25-75 percentile);	1.27(0.96-1.71)	1.22(0.90-1.69)	0.388
Hemoglobin (g/dL)^† † n (%)	12.9(4.1)	12.5(4.1)	0.350
Time of disease, days^‡ ‡ median (25-75 percentile);	32.2(1-365)	27.8(0-725)	0.584
Does treatment for HF^† † n (%)	273(88.9)	215(86.3)	0.028

Variable	Total^* * n (%); n = 556	Gross Value PR (CI 95%) P	Adjusted Value PR (CI 95%) P
Sex, male	362(65.1)	1.18(1.03-1.35) 0.02	1.11(0.97-1.27) 0.14
Skin color
White	371(66.7)	1.00	1.00
Black	89(16)	0.93(0.84-1.02) 0.14	0.86 (0.70-1.05) 0.14
Brown	96(17.2)	0.67(0.54-0.82) <0.001	0.91(0.82-1.00) 0.06
Etiology, ischemic	204(37.2)	0.83(0.71-0.96) 0.01	0.81(0.69-0.95) 0.01
Paroxysmal nocturnal dyspnea	471(84.7)	1.37(1.18-1.59) <0,001	1.21(0.96-1.53) 0.11
Irregular use of medications in the last week	154(27.6)	1.26(1.10-1.45) 0.001	1.22(1.02-1.46) 0.03
Stopped taking medication when felt better	76(13.6)	1.38(1.26-1.52) <0.001	1.19(1.07-1.32) <0.001
Relates importance of weight in treatment	173 (31.1)	1.59(1.15-2.21) 0.005	1.12(0.90-1.40) 0.32
Related congestion with orthopnea	179(32.1)	1.73(1.04-2.86) 0.03	1.14(0.72-1.79) 0.57
Related congestion with swelling of the extremities	259(46.5)	2.04(1.76-2.37) <0.001	1.45(0.83-2.54) 0.19
Related congestion with PND	157(28.2)	2.00(1.36-2.95) <0.001	1.33(0.97-1.83) 0.07
Does not relate tiredness with the worsening of the disease	269(48.3)	1.77(1.31-2.38) <0.001	0.89(0.83-0.94) <0.001

Variable	Poor adherence^* * n (%) n = 307	Other causes^* * n (%) n = 249	Adjusted Value PR (CI 95%)	P value
Need for MV	15(4.9)	20(8)	0.60(0.33-1.08)	0.093
Hemodialysis	8(2.6)	8(3.2)	0.80(0.54-1.20)	0.30
Admission ICU	37(12.1)	36 14.5)	0.83(0.52-1.31)	0.60
Use of Inotrope	25(8.1)	28(11)	0.72(0.45-1.14)	0.16
Death	18(5.9)	24(9.6)	0.60(0.58-0.63)	<0.001

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[1] Corresponding author:
Eneida Rejane Rabelo-Silva. eneidarabelo@gmail.com