Abstract 4608: Adherence To Non-pharmacological Recommendations In Heart Failure Patients Is Associated With Better Outcome: Data From COACH
Background and aim of the study Although it is generally suggested that adherence to non-pharmacological treatment may favorably affect outcome in heart failure (HF) patients, there are no data to support this statement. We therefore examined the association between adherence to non-pharmacological treatment, and mortality, hospital readmission and number of days hospitalized for HF or death.
Method A total of 802 HF patients (mean age 70 ± 11; 37% female; mean LVEF 34% ± 14) were included in the study. All patients participated in the COACH-study, a study of the effect of education and counseling in HF patients, in which patients were followed for 18 months. Baseline characteristics were assessed and patients completed validated questionnaires on adherence to non-pharmacological recommendations (diet, fluid restriction, weighing and exercise) and on depressive symptoms. Patients were defined as adherent when they reported following all recommendations ‘always’ or ‘most of the time’. The association between adherence to non-pharmacological treatment at 1 month and outcome was calculated using Cox-regression analysis. Differences in days hospitalized for HF or death were assessed using Mann-Whitney tests.
Results A total of 48% of patients were adherent to the non-pharmacological recommendations (daily weighing, diet, fluid restriction and exercise). Non-adherent patients (52%) were significantly older (72 vs. 68 years; p<.001), had a higher NYHA functional class 50% in class III vs. 40%); p=.009) and more often had depressive symptoms (43% vs. 35%; p=.03). Patients who were non-adherent to non-pharmacological recommendations had an increased risk for mortality (HR 1,44; p=.038) and HF readmission (HR 1,52; p=.012). Data were adjusted for age, NYHA-functional class and depressive symptoms. Also, non-adherent patients had more days of hospitalization for HF or death compared to adherent patients (100.4 vs. 51.7; p = .005)
Conclusion Non-adherence to non-pharmacological HF recommendations (diet, fluid restriction, weighing and exercise) is associated with a significant increase in mortality and hospitalization for HF.