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Compliance with a complex healthcare regimen is required of most patients with heart failure. Noncompliance with even some aspects of the recommended treatment can lead to repeated and preventable hospitalizations, or even death. This paper reviews the extent of noncompliance for general health-seeking behavior and recommended lifestyle modifications in the general population, as well as the research on compliance conducted specifically in patients with heart failure. Research findings are reviewed in three areas: the extent and predictors of compliance, the relationship of compliance and clinical outcomes, and interventions designed to increase compliance in heart failure patients. Based on research findings to date, strategies to enhance compliance are offered. (Prog Cardiovasc Nurs;15:97-103) (C)2000 by CHF, Inc.
Compliance with prescribed therapeutic regimens has been a documented concern to health professionals since the time of Hippocrates. The concern persists today as reflected in over 14,000 published reports on the topic and investigations of more than 250 variables as possible etiologies for compliance found in the research literature. Patient compliance with medical regimens is a behavioral problem of interest because it affects the patient's health. If the therapeutic regimen is to be effective, the patient must comply with that regimen. No regimen of medication, diet, or behavioral change will benefit a patient who does not follow it.
This paper describes the scope of compliance as a behavioral phenomenon in heart failure (HF) patients. Initially, a discussion of why HF and compliance are significant issues in health care today is presented. Current issues and research related to compliance in HF patients are described, particularly the manner in which compliance with medical regimens may affect health outcomes (including morbidity and mortality), health care costs, and quality of life (QOL). Finally, various strategies to deal with poor compliance among HF patients are presented to guide cardiovascular nurses who care for HF patients.
HEART FAILURE: A GROWING EPIDEMIC
HF is the most rapidly growing cardiovascular disorder in the U.S. About 4,900,000 Americans have HF and approximately 400,000 new cases occur each year.2 The magnitude of the problem is expected to increase, because as more and more cardiac patients are able to survive and live longer with their disease, their opportunity for developing HF increases. Furthermore, the future growth in the elderly...