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European Heart Journal Advance Access published online on October 17, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi603
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received December 9, 2004
Revised September 23, 2005
Accepted September 29, 2005

Clinical research

Compliance in heart failure patients: the importance of knowledge and beliefs

Martje H.L. van der Wal 1*, Tiny Jaarsma 1, Debra K. Moser 2, Nic J.G.M. Veeger 3, Wiek H. van Gilst 4, and Dirk J. van Veldhuisen 1

1 Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands
2 College of Nursing, University of Kentucky, Lexington, KY, USA
3 Trial Coordination Center, University Medical Center Groningen, University of Groningen, The Netherlands
4 Department of Cardiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen, The Netherlands; Department of Clinical Pharmacology, University Medical Center Groningen, University of Groningen, The Netherlands

* To whom correspondence should be addressed.
Martje H.L. van der Wal, E-mail: m.h.l.van.der.wal{at}thorax.umcg.nl


  Abstract

Aims Non-compliance in patients with heart failure (HF) contributes to worsening HF symptoms and may lead to hospitalization. Several smaller studies have examined compliance in HF, but all were limited as they only studied either the individual components of compliance and its related factors or several aspects of compliance without studying the related factors. The aims of this study were to examine all dimensions of compliance and its related factors in one HF population.

Methods and results Data were collected in a cohort of 501 HF patients. Clinical and demographic data were assessed and patients completed questionnaires on compliance, beliefs, knowledge, and self-care behaviour. Overall compliance was 72% in this older HF population. Compliance with medication and appointment keeping was high (>90%). In contrast, compliance with diet (83%), fluid restriction (73%), exercise (39%), and weighing (35%) was markedly lower. Compliance was related to knowledge (OR = 5.67; CI 2.87-11.19), beliefs (OR = 1.78; CI 1.18-2.69), and depressive symptoms (OR = 0.53; CI 0.35-0.78).

Conclusion Although some aspects of compliance had an acceptable level, compliance with weighing and exercise were low. In order to improve compliance, an increase of knowledge and a change of patient's beliefs by education and counselling are recommended. Extra attention should be paid to patients with depressive symptoms.

Keywords: Patient compliance; Adherence; Nursing; Heart failure.
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