The aim of this systematic review and meta-analysis was to estimate medication adherence in hypertensive patients aged ≥60 years and to explore potential determinants of adherence with ...antihypertensive treatment in this age group.
A systematic search of the PubMed, Scopus, and Google Scholar using the Cochrane guidelines was performed. The analysis included articles published between 1 January 2000 and 30 June 2018. The patients were considered adherent if they scored ≥6 pts. on the Morisky Medication Adherence Scale (MMAS-8) or ≥3 pts. on the Morisky Green Levine Medication Adherence Scale (MGL). If available, also odds ratios (OR) with 95% confidence intervals (95% CI) for determinants of medication adherence were recorded.
Thirteen studies including a total of 5,247 patients were available for the meta-analysis. The pooled percentage of adherence was 68.86% (95% CI: 57.80-79.92%). Subgroup analysis did not demonstrate a significant difference in the adherence measured with the MMAS-8 and the MGL (68.31 vs. 70.39%,
= 0.773). The adherence of patients from Western countries (Europe, United States) turned out to be significantly higher than in other patients (83.87 vs. 54.30%,
= 0.004). The significant determinants of better adherence identified in more than one study were older age, retirement/unemployment, duration of hypertension >10 years, and a lower number of prescribed drugs.
Medication adherence in the oldest old hypertensive patients seems to be higher than in younger persons. Adherence in older persons was associated with age, socioeconomic status, and therapy-related factors.
Introduction: The aim of the study was to assess the prevalence of frailty among elderly patients who had an implanted cardioverter defibrillator, as well as the influence of frailty on the main ...endpoints during the follow-up. Methods: The study included 103 patients > 60 years of age (85M, aged 71.56–8.17 years). All of the patients had an implanted single or dual-chamber cardioverter-defibrillator. In the research, there was a 12-month follow-up. The occurrence of frailty syndrome was assessed using the Tilburg Frailty Indicator scale (TFI). Results: Frailty syndrome was diagnosed in 75.73% of the patients that were included in the study. The mean values of the TFI were 6.55 ± 2.67, in the physical domain 4.06 ± 1.79, in the psychological domain 2.06 ± 1.10, and in the social domain 0.44 ± 0.55. During the follow-up period, 27.2% of patients had a defibrillator cardioverter electric shock, which occurred statistically more often in patients with diagnosed frailty syndrome (34.6%) compared to the robust patients (4%); p = 0.0062. In the logistic regression, frailty (OR: 1.203, 95% CI:1.0126–1.4298; p < 0.030) was an independent predictor of a defibrillator cardioverter electric shock. Similarly, in the logistic regression, frailty (OR: 1.3623, 95% CI:1.0290–1.8035; p = 0.019) was also an independent predictor for inadequate electric shocks. Conclusion: About three-quarters of the elderly patients that had qualified for ICD implantation were affected by frailty syndrome. In the frailty subgroup, adequate and inadequate shocks occurred more often compared to the robust patients.
Background. Hypertension is considered to be the most common condition in the general population. It is the most important risk factor for premature deaths in the world. Treatment compliance at every ...stage is a condition for successful antihypertensive therapy, and improving the effectiveness of treatment is a major goal in preventing cardiovascular incidents. Treatment noncompliance and lack of cooperation stem from numerous problems of older age, including frailty syndrome. Objective. To evaluate the effect of frailty syndrome on treatment compliance in older patients with hypertension. Methods. The study sample consisted of 160 patients (91 women, 69 men) with hypertension aged 65 to 78 (mean = 72.09, SD = 7.98 years), hospitalized at the University Clinical Hospital due to exacerbation of disease symptoms. Standardised research tools were used: the Tilburg Frailty Indicator questionnaire and the questionnaire for the assessment of treatment compliance in patients with hypertension, the Hill-Bone Compliance to High Blood Pressure Therapy Scale. Results. Frailty syndrome was diagnosed in 65.62% of patients: 35.62% with mild, 29.38% with moderate, and 0.62% with severe frailty. The treatment compliance was 36.14%. The prevalence of the FS and its three components (physical, psychological, social) significantly affected (p <0.05) the global score of the Hill-Bone Compliance to High Blood Pressure Therapy Scale and all subscales: “reduced sodium intake”, “appointment keeping”, and “antihypertensive medication taking”. Conclusions. The coexistence of frailty syndrome has a negative impact on the compliance of older patients with hypertension. Diagnosis of frailty and of the associated difficulties in adhering to treatment may allow for targeting the older patients with a poorer prognosis and at risk of complications from untreated or undertreated hypertension and for planning interventions to improve hypertension control.
During childhood and adolescence, skeletal microarchitecture and bone mineral density (BMD) undergo significant changes. Peak bone mass is built and its level significantly affects the condition of ...bones in later years of life. Understanding the modifiable factors that improve bone parameters at an early age is necessary to early prevent osteoporosis. To identify these modifiable factors we analysed the relationship between dairy product consumption, eating habits, sedentary behaviour, and level of physical activity with BMD in 115 young boys (14-17 years).
Bone parameters were measured by dual energy x-ray absorptiometry using paediatric specific software to compile the data. Dairy product consumption and eating habits were assessed by means of a dietary interview. Sedentary behaviour and physical activity was assessed in a face-to-face interview conducted using the International Physical Activity Questionnaire. Data collection on total physical activity level was performed by collecting information on the number of days and the duration of vigorous and moderate intensity (MVPA) and average daily time spent in sitting (SIT time).
The strongest relationships with BMD in distal part of forearm were found for moderate plus vigorous activity, sit time, and intake of dairy products, intake of calcium, protein, vitamin D, phosphorus from diet. Relationships between BMD, bone mineral content (BMC) in the distal and proximal part of the forearm and PA, sit time and eating parameters were evaluated using the multiple forward stepwise regression. The presented model explained 48-67% (adjusted R
= 0.48-0.67; p < 0.001) of the variance in bone parameters. The predictor of interactions of three variables: protein intake (g/person/day), vitamin D intake (µg/day) and phosphorus intake (mg/day) was significant for BMD dis (adjusted R
= 0.59; p < 0.001). The predictor of interactions of two variables: SIT time (h/day) and dairy products (n/day) was significant for BMD prox (adjusted R
= 0.48; p < 0.001). Furthermore, the predictor of interactions dairy products (n/day), protein intake (g/person/day) and phosphorus intake (mg/day) was significant for BMC prox and dis (adjusted R
= 0.63-0.67; p < 0.001).
High physical activity and optimal eating habits especially adequate intake of important dietary components for bone health such as calcium, protein, vitamin D and phosphorus affect the mineralization of forearm bones.
To estimate the risk of all‐cause mortality and hospitalization in frail patients with chronic heart failure (HF), a systematic search and meta‐analysis was carried out to identify all prospective ...cohort studies conducted among adults with HF where frailty was quantified and related to the primary endpoints of all‐cause mortality and/or hospitalization. Twenty‐nine studies reporting the link between frailty and all‐cause mortality in 18 757 patients were available for the meta‐analysis, along with 11 studies, with 13 525 patients, reporting the association between frailty and hospitalization. Frailty was a predictor of all‐cause mortality and hospitalization with summary hazard ratios (HRs) of 1.48 95% confidence interval (CI): 1.31–1.65, P < 0.001 and 1.40 (95% CI: 1.27–1.54, P < 0.001), respectively. Summary HRs for all‐cause mortality among frail inpatients undergoing ventricular assist device implantation, inpatients hospitalized for HF, and outpatients were 1.46 (95% CI: 1.18–1.73, P < 0.001), 1.58 (95% CI: 0.94–2.22, P = not significant), and 1.53 (95% CI: 1.28–1.78, P < 0.001), respectively. Summary HRs for all‐cause mortality and frailty based on Fried's phenotype were 1.48 (95% CI: 1.03–1.93, P < 0.001) and 1.42 (95% CI: 1.05–1.79, P < 0.001) for inpatients and outpatients, respectively, and based on other frailty measures were 1.42 (95% CI: 1.12–1.72, P < 0.001) and 1.60 (95% CI: 1.43–1.77, P < 0.001) for inpatients and outpatients, respectively. Across clinical contexts, frailty in chronic HF is associated with an average of 48% and 40% increase in the hazard of all‐cause mortality and hospitalization, respectively. The relationship between frailty and all‐cause mortality is similar across clinical settings and comparing measurement using Fried's phenotype or other measures.
Contemporarily, cardiac arrest (CA) remains one of the leading causes of death. Poor nutritional status can increase the post-CA mortality risk. The aim of this study was to determine the ...relationship between body mass index (BMI) and Nutritional Risk Score 2002 (NRS 2002) results and in-hospital mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest.
A retrospective study and analysis of medical records of 161 patients admitted to the ICU of the University Clinical Hospital in Wrocław (Wrocław, Poland) was conducted.
No significant differences in body mass index (BMI) and nutritional risk score (NRS 2002) values were observed between non-survivors and survivors. Non-survivors had significantly lower albumin concentration (
= 0.017) and total cholesterol (TC) (
= 0.015). In multivariate analysis BMI and NRS 2002 scores were not, per se, associated with the in-hospital mortality defined as the odds of death (Model 1:
: 0.700, 0.430; Model 2:
: 0.576, 0.599). Univariate analysis revealed significant associations between the hazard ratio (HR) and TG (
≈ 0.017, HR: 0.23) and hsCRP (
≈ 0.018, HR: 0.34). In multivariate analysis, mortality risk over time was influenced by higher scores in parameters such as BMI (HR = 0.164;
= 0.048) and hsCRP (HR = 1.006,
= 0.002).
BMI and NRS 2002, on their own (unconditionally - in the whole study group) did not alter the odds of mortality in patients admitted to the intensive care unit (ICU) after in-hospital and out-of-hospital cardiac arrest. The risk of in-hospital mortality (expressed as hazard ratio - the risk over the time period of the study) increased with an increase in BMI but not with NRS 2002.
Despite advances in the treatment of heart failure (HF), the physical symptoms and stress of the disease continue to negatively impact patients’ health outcomes. Technology now offers promising ways ...to integrate personalized support from health care professionals
via
a variety of platforms. Digital health technology solutions using mobile devices or those that allow remote patient monitoring are potentially more cost effective and may replace in-person interaction. Notably, digital health methods may not only improve clinical outcomes but may also improve the psycho-social status of HF patients. Using digital health to address biopsychosocial variables, including elements of the person and their context is valuable when considering chronic illness and HF in particular, given the multiple, cross-level factors affecting chronic illness clinical management needed for HF self-care.
Hypertension is one of the most important risk factors for cardiovascular disease, which contributes to lowering the quality of life (QOL), especially in elderly patients. Recent data show that ...almost half of the hypertensive patients and one-third of patients with comorbidities were nonadherent to medication.
To assess the association of QOL with the level of adherence and to examine the association with selected variables on the level of adherence.
A prospective, cross-sectional, and analytical study.
This study involved 186 hypertensive elderly patients (mean age: 71.05±7.47 years). An analysis of medical records based on sociodemographic and clinical data was conducted. The World Health Organization Quality of Life Scale Brief version (WHOQOL-BREF) was used to assess the level of QOL, and the Hill-Bone Compliance to High Blood Pressure Therapy Scale (HBQ) was used to examine the level of adherence to therapeutic recommendations in hypertensive patients.
The average assessment of the QOL measured by the WHOQOL-BREF questionnaire was 3.36±0.84 points, which indicates a QOL at a level between average and good. The patients' average score on the HBQ questionnaire was 20.39±4.31 points. In the "reduced sodium intake" subscale, patients had an average of 4.75±1.33 points. In the "appointment keeping" subscale, the patients scored an average of 3.45±1.07 points. In the "medication taking" subscale, the patients had an average of 12.19±3.46 points. It was shown that the total score of the HBQ questionnaire was negatively correlated with all domains of QOL assessed with the WHOQOL-BREF questionnaire (
<0.05).
There is an association between QOL and adherence to therapeutic recommendations among hypertensive elderly patients. It has been concluded that with an increasing QOL, the level of adherence to therapeutic recommendations increases. The level of adherence is also negatively affected by: older age, longer duration of disease, worse marital status, lower education, living alone, and using polytherapy.
Introduction: In a long-term approach to the treatment of heart failure, importance is given to the process of self-care management and behaviors. The number of rehospitalizations and unscheduled ...medical visits can be reduced by actively engaging patients in the self-care process. Methods: The study included 403 patients with chronic heart failure (mean LVEF 40.53%), hospitalized in the Cardiology Department. Medical record analysis and a self-report questionnaire were used to obtain basic sociodemographic and clinical data. The European Heart Failure Self-care Behavior Scale, revised into a nine-item scale (EHFScBS-9), was used to evaluate self-care behavior. Results: Analysis of the EHFSc-9 self-care behavior scale showed that the mean score was 49.55 out of 100 possible points (SD = 22.07). Univariate analysis revealed that significant (p < 0.05) negative predictors of the EHFScB-9 self-care scale included: male sex (b = −5146), hospitalizations in the last year (b = −5488), NYHA class II (b = −11,797) and NYHA IV class (b = −15,196). The multivariate linear regression model showed that a significant (p ˂ 0.05) negative predictor of the EHFScB-9 self-care scale was male sex (b = −5.575). Conclusions: Patients with chronic HF achieve near optimal self-care behavior outcomes. A patient prepared to engage with self-care will have fewer rehospitalizations and a better quality of life.
A number of factors influence mortality in post-cardiac-arrest (CA) patients, nutritional status being one of them. The aim of this study was to assess whether there are sex differences in the ...prognostic impact of BMI, as calculated on admission to an intensive care unit, on in-hospital mortality in sudden cardiac arrest (SCA) survivors.
We carried out a retrospective analysis of data of 129 post-cardiac-arrest patients with return of spontaneous circulation (ROSC) admitted to the Intensive Care Unit (ICU) of the University Teaching Hospital in Wrocław between 2017 and 2022.
Female patients were significantly older than male patients (68.62 ± 14.77 vs. 62.7 ± 13.95). The results of univariable logistic regression analysis showed that BMI was not associated with the odds of in-hospital death in either male or female patients. In an age-adjusted model, age was an independent predictor of the odds of in-hospital death only in male patients (OR = 1.034). In our final multiple logistic regression model, adjusted for the remaining variables, none of the traits analysed were a significant independent predictor of the odds of in-hospital death in female patients, whereas an initial rhythm of ventricular fibrillation or pulseless ventricular tachycardia (VF/pVT) was an independent predictor of the odds of in-hospital death in male patients (OR = 0.247).
BMI on admission to ICU is not a predictor of the odds of in-hospital death in either male or female SCA survivors.
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