Compliance to treatment and quality of life of Sudanese patients with heart failure
Mugahed AL-khadher
a,*
,Imad Fadl-Elmula
b ,
Waled Amen Mohammed Ahmed
c
Abstract
Background:
Heart failure is known to decrease the quality of life, especially in non-compliance patients with regards to medications and life style changes.
Objective:
The present study aimed to determine the level of compliance to treatment and quality of life of Sudanese patients with heart failure.
Methods:
This descriptive study was conducted on 76 patients with heart failure admitted to the Sudan Heart Institute. Demographic and clinical data including the compliance (medication, sodium restriction, fluid restriction, daily weights, exercises, and appointment-keeping) were collected. The quality of life was measured using the Minnesota living with heart failure Questionnaire. The data were collected from all patients and the analyzed using SPSS version 22 software.
Results:
Heart failure patients showed low compliance ranged between 11.84% and 75% of which the highest compliance was to medication (75%) followed by the follow-up appointments (71.05%), and the lowest compliances were to the fluids restrictions (11.84%), the weight monitoring (17.10%), regular exercise (21.05%), and the sodium restriction (27.6%). Quality of life score ranged between 62-97 score and the Mean (SD)
83.6
(7.82) which reveled of poor quality of life in most of Sudanese patients with heart failure involved in the present study.
Conclusion:
The study showed that patients with heart failure in Sudan have low compliance to treatment and poor quality of life.
Key
words
Heart Failure, Treatment Compliance, Quality of life, Sudan
Introduction:
Heart failure incidence increases with age, increase from approximately 20 per 1000 individuals with age 65 to 69-year-old to more than 80 per 1000 individuals aging 85-year-old (1). In fact few epidemiological data on heart failure in Sudan exists and the recognition of the disease as a major health issue remains questionable, the prevalent of heart failure accounts for 2.5% of the population, and hence it is one of the major causes of hospital mortality (2).
The WHO defined adherence as extent a persons behavior taking drugs, following a diet, and/or executing lifestyle modifications, follow the agreed recommendations from a health care providers (3). Poor compliance noncompliance usually refers to patients failure to follow health interventions as recommended by the health care provider, but it can also refer to the providers failure to act according to practice guidelines or standards of care(4). The factors affecting the compliance could be divided into patient-related factors, regimen-related factors, and health care providers-related factors (5).
Non-compliance to medications and diet contributes in many cases to worsening heart failure symptoms. The compliance to prescribe medications or other caregivers recommendations such as lifestyle changes is a widely acknowledged problem leading to hospitalization ((6-8). The non-compliance of HF patients is a major problem and remains to be a continuous source of concern for patients. It is mainly for diet and fluid, daily weight and exercises (9).
Quality of life (QOL) is defined as the individuals unique cognition and a way to express feelings about his/her health status(10).Moreover, QOL is a good predictor of mortality and the need for hospitalization (11-13). Patients in class II and III heart failure of New York Heart Association (NYHA) classification cannot normally do their daily activities (9).
Although, several studies on compliance of HF patients and their quality of life have been performed worldwide, to our knowledge this is the first ever study conducted in Sudanese HF patients, aimed to assess the compliance to treatment and quality of life in Sudanese patients with heart failure.
Materials and Methods
This descriptive study was conducted on 76 patients with heart failure admitted to the Sudan Heart Institute. A total of 76 Sudanese HF patients were randomly selected from Sudan Heart Institute in Khartoum, January-March 2014. The patients participated were above 20 years, confirmed diagnosed as heart failure by the cardiologist at least a month, already start HF treatment, in class II or III heart failure of NYHA, and with ability to communicate.
The questionnaire consists of 36 questions of which 10 for demographic and clinical data, 5 questions for compliance, and 21 questions for quality of life. Demographic and clinical data were collected from medical records and/or by interviews. The demographic data included age, gender, educational level, and marital status, whereas clinical variables include left ventricular ejection fraction (EF), previous hospitalization in the past three months, and duration of HF.
Revised HF Compliance Questionnaire was used (14), on a five-point scale (1=never; 2= seldom; 3= half of the time; 4 =mostly; 5=always) (15). the participants compliance to medications, diet, fluid restriction, exercise, weight, and appointment keeping was evaluated by asking patients to rate their compliance of the last week (drugs, diet modifications, fluid restriction, and exercises), the last month (daily weighing), and the last 3 months (appointment keeping) before hospitalization. The patients were divided into two groups; either compliant or noncompliant (16-19). Patients were considered overall compliant the compliance with four or more of the six recommendations.(20) (Table 2).
The quality of life data were collected and measured using the Minnesota Living with Heart Failure Questionnaire after translated to Arabic language (9). This instrument used most widely to evaluate quality of life in research studies (21-24) .Which Contains 21 questions and overall score of 105 (5×21) with possible answers ranging from 0 (no) to 5 (very much), (0= no; 1= Very Little ; 2= little: 3= moderate; 4= much; 5= very much). The final score is the sum points obtained for the 21 questions; it can therefore vary between 0 and 105. It evaluates how heart failure affects patients physical (8 questions), emotional (5 questions), and socioeconomic (8 questions) dimensions (25). The sum of responses reflects the overall effects of heart failure and treatments on individuals quality of life (9).
Data was presented using descriptive statistics including frequency, percentage, mean with standard deviation (SD) and P-value of ?0.05 was considered statistically significant for relationship investigations. Ethical approval was obtained from Al Neelain Ethical committee at Al Neelain University. All patients signed an informed consent before participate in the study.
Results
The study showed that out the 76 patients, 63.2% were male and 36.8% were female; the mean age was 61.4 ±13.5 years. The education levels were 34.2% of patients were illiterate, 32.9% had completed primary school, 19.7% secondary school, and 13.2% had university graduation (
Table 1
).
Although the vast majority of the patients were chronic patients with diagnosis for more than 5 years, the participant ask to define what is the heart failure? Only 24% had basic conscious about their disease, the remaining 76% of patients had no idea what the heart failure is. Overall compliance among the patients was 28.95%, whereas 71.5% of the patients were classified as non-compliant. Of those compliance with medication was 75% and 70% compliance with appointment-keeping. In general most patients showed low compliance with diet restriction (27%), exercise (21%), weighing (17%), and fluid restriction (11%) (
Table2
).
The quality of life data showed that poor quality of life, the score ranged from 62-97 score /105, and the Mean (SD) quality of life was 3.2 (1.3) which reveled of poor quality of life in most of Sudanese patients with heart failure involved in the present study .There is statistically significant in compliance and quality of life (p value= 0.002) in compression with patients who is noncompliant. Also statistically significant with improved NYHA classification, LVEF and quality of life (p<0.001), others demographic and clinical data showed statistically insignificant (
Table 3
).
(Table.1): Demographic and clinical variables of the study population (n=76)
in Sudan.
|
|
|
|
|
|
|
Mean (SD) |
61.4 ±13.5 |
|
|
|
Male Female |
48 28 |
63.2% 36.8 % |
|
|
Married Single Widowed Divorced |
55 8 11 2 |
72.4% 10.5% 14.5% 2.6% |
|
|
Employed Unemployed Retired |
27 38 11 |
35% 50.5% 14.5 % |
|
|
Non Primary Secondary University/college |
26 25 15 10 |
34.% 232.9% 19.7% 13.2% |
|
|
Less than one year ago One to three year ago Four years and above ago |
38 30 8 |
50.0% 39.47% 10.5 % |
|
|
Class II Class III Class IV |
38 33 5 |
55.0 % 43.4% 6.6 % |
|
|
mean (SD) |
37 ±14 |
|
|
|
No admission One admission >1 |
21 29 26 |
27.6% 38.2 % 34.2 % |
(Table.2) Compliance (Medications, diet, Fluid restriction, Exercise, weight, and
appointments keeping) in Sudan.
|
|
|
|
|
|
|
Do you take your medications exactly as directed? |
(75%) 57 |
25% ) 19 |
|
|
Do you weigh yourself daily? Or at least three times/week? |
(17.10 %) 13 |
(82.89%) 63 |
|
|
Do you follow a low sodium diet? |
(27.63%) 21 |
(72.36 %) 55 |
|
|
Do you avoid drinking excess fluids? |
(11.84%) 9 |
(88.15 %) 67 |
|
|
Do you get regular exercise? |
(21.05)% 16 |
(78.9%) 60 |
|
|
Do you Keep follow-up appointments? |
(71.05) % 54 |
(28..9% ) 22 |
(Table.3) Quality of life of heart failure patients
in Sudan (N=76)
|
|
|
|
|
Causing swelling in your ankles or legs? |
3.8026 |
1.11976 |
|
Making you sit or lie down to rest during the day? |
3.5395 |
1.47369 |
|
Making your working around the house or yard difficult? |
3.5132 |
1.21648 |
|
Making your going places away from home difficult? |
3.8421 |
1.49713 |
|
Making your sleeping well at night difficult? |
3.5395 |
1.30067 |
|
Making your relating to or doing things with your friends or family difficult? |
3.8421 |
1.37649 |
|
Making your working to earn a living difficult? |
3.6974 |
1.39542 |
|
Making your recreational pastimes, sports or hobbies difficult? |
4.2368 |
1.00490 |
|
Making your sexual activities difficult? |
4.5658 |
.86926 |
|
Making you eat less of the foods you like? |
3.9737 |
1.49643 |
|
Making you tired, fatigued, or low on energy? |
4.5263 |
1.02598 |
|
Making you stay in a hospital? |
3.9079 |
1.23480 |
|
Costing you money for medical care? |
4.1316 |
1.19267 |
|
Giving you side effects from treatments? |
4.2895 |
.97729 |
|
Making you feel a loss of self-control in your life? |
4.0395 |
1.18255 |
|
Making you worry? |
4.2895 |
1.16408 |
|
Making your walking about or climbing stairs difficult? |
4.0658 |
1.35976 |
|
Making you tired, fatigued, or low on energy? |
4.1447 |
1.16280 |
|
Making you feel you are a burden to your family or friends? |
3.9737 |
1.35621 |
|
Making it difficult for you to concentrate or remember things? |
3.8553 |
1.50292 |
|
Making you feel depressed? |
3.8553 |
1.19671 |
|
|
|
|
|
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