Abstract 1553: Medication Adherence Mediates the Relationship Between Marital Status and Event-Free Survival in Patients With Heart Failure
Background: Medication adherence is essential to achieving better outcomes. Prognosis is worse in unmarried compared to married patients (pts) with heart failure (HF). The reasons for differences in outcomes are unclear, but differences in medication adherence may play a role.
Objective: To determine whether medication adherence mediates the relationship between marital status and event-free survival in HF pts.
Method: Demographic, clinical and psychosocial data were collected by questionnaires and medical record on 136 HF pts (male 70%, married 62%, age 61±11 years, NYHA III/IV 60%).. Medication adherence was monitored objectively for 3 months using the Medication Event Monitoring System. Event-free survival data were obtained by patient/family interview, hospital data base and death certificate review. A series of regression and Cox-survival analyses were done to determine whether adherence mediated the relationship of marital status to event-free survival.
RESULTS: Event-free survival was worse in unmarried patients than married patients (Figure 1⇓). Unmarried pts were more likely to be nonadherent (p=.031) and were1.97 times more likely to experience an event than married pts (p=.038). Marital status was not a significant predictor of event-free survival after entering adherence in the model, demonstrating mediation (p=.10).
CONCLUSION: Medication adherence mediated the relationship between marital status and event-free survival. It is important to design interventions to increase medication adherence that take into account subgroups, such as unmarried pts, who are at risk for nonadherence.
This research has received full or partial funding support from the American Heart Association, Great Rivers Affiliate (Delaware, Kentucky, Ohio, Pennsylvania & West Virginia).