Cognitive Function and Treatment Adherence in Older Adults With Heart Failure Effectiveness of implementation strategies in improving physician adherence to guideline recommendations in heart failure: a systematic review protocol The Home-Heart-Walk study, a self-administered walk test on perceived physical functioning, and self-care behaviour in people with stable chronic heart failure: A randomized controlled trial Adherence to self-care recommendations and associated factors among adult heart failure patients. From the patients’ point of view Effects of an exercise adherence intervention on outcomes in patients with heart failure. Impact of the Dash Diet on Endothelial Function, Exercise Capacity, and Quality of Life in Patients with Heart Failure Adherence to guideline-recommended adjunctive heart failure therapies among outpatient cardiology practices (findings from IMPROVE HF). Study of adherence to exercise in heart failure: the HEART camp trial protocol Investigating a TELEmedicine solution to improve MEDication adherence in chronic Heart Failure (TELEMED-HF): study protocol for a randomized controlled trial A randomized controlled pilot study of outcomes of strict allowance of fluid therapy in hyponatremic heart failure (SALT-HF). Type D Personality Predicts Poor Medication Adherence in Patients with Heart Failure in the USA Increasing exercise capacity and quality of life of patients with heart failure through Wii gaming: the rationale, design and methodology of the HF‐Wii study; a multicentre randomized controlled trial The Heart Failure Adherence and Retention Trial (HART): design and rationale. Randomized controlled feasibility trial of two telemedicine medication reminder systems for older adults with heart failure Adherence to clinical guidelines in heart failure (HF) outpatients: Impact of an interprofessional HF team on evidence-based medication use
Objective Treatment recommendation and guidelines for patients with heart failure ( HF ) can be complex , and past work has shown that patients with HF demonstrate low rates of adherence to recommended health behaviors . Although previous work has identified several medical , demographic , and psychosocial predictors of the capacity to adhere to treatment recommendations of persons with HF , little is known about the contribution of cognitive impairment to reported treatment adherence in this population . Methods A total of 149 persons with HF ( mean [ st and ard deviation ] = 68.08 [ 10.74 ] years ) completed a brief fitness assessment and neuropsychological testing . Treatment adherence was assessed using the  Heart Failure Compliance Question naire , a brief measure that asks participants to report their adherence to a variety of recommended health behaviors ( i.e. , medication management , diet , and exercise , among others ) . Results The percentage of participants who reported poor overall adherence was 16.1 % , with particularly high rates of nonadherence to dietary and exercise recommendations . Hierarchical regression analyses adjusting for possible confounds revealed that reduced performance on attention ( & bgr ; = .26 , p = .01 ) , executive function ( & bgr ; = .18 , p = .04 ) , and language ( & bgr ; = .22 , p = .01 ) was associated with poorer overall adherence . Follow-up analyses showed that these cognitive domains were associated with behaviors such as keeping doctor appointments , medication management , and dietary recommendations ( p < .05 for all ) . Conclusions The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF . Prospect i ve studies that objective ly measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population . Trial Registration : clinical trials.gov Identifier : NCT00871897 Introduction The uptake of Clinical Practice Guideline ( CPG ) recommendations that improve outcomes in heart failure ( HF ) remains suboptimal . We will conduct a systematic review to identify implementation strategies that improve physician adherence to class I recommendations , those with clear evidence that benefits outweigh the risks . We will use American , Canadian and European HF guidelines as our reference . Methods and analysis We will conduct a literature search in the data bases of MEDLINE , EMBASE , HEALTHSTAR , CINAHL , Cochrane Library , Campbell Collaboration , Joanna Briggs Institute Evidence Based Practice , Centre for Review s and Dissemination and Evidence Based Practice Centres . We will include prospect i ve studies evaluating implementation interventions aim ed at improving uptake of class I CPG recommendations in HF . We will extract data in duplicate . We will classify interventions according to their level of application ( ie , provider , organisation , systems level ) and common underlying characteristics ( eg , education , decision-support , financial incentives ) using the Cochrane Effective Practice and Organisation of Care Taxonomy . We will assess the impact of the intervention on adherence to the CPGs . Outcomes will include proportion of eligible patients who were : prescribed a CPG-recommended pharmacological treatment ; referred for device consideration ; provided self-care education at discharge ; and provided left ventricular function assessment . We will include clinical outcomes such as hospitalisations , readmissions and mortality , if data is available . We will identify the common elements of successful and failing interventions , and examine the context in which they were applied , using the Process Re design context ual framework . We will synthesis e the results narratively and , if appropriate , will pool results for meta- analysis . Discussion and dissemination In this review , we will assess the impact of implementation strategies and context ual factors on physician adherence to HF CPGs . We will explore why some interventions may succeed in one setting and fail in another . We will disseminate our findings through briefing reports , publications and presentations . Trial registration number CRD42015017155 Background : Adherence to self-care recommendations is associated with improved patient outcomes and improved quality of life for people living with heart failure .  The Home-Heart-Walk ( HHW ) is an intervention to promote physical activity adapting the elements of a six minute walk test , a reliable and valid measure . This adaptation was design ed to support self-monitoring of physical functioning and promote the self-care of people with heart failure . The primary outcome of the Home-Heart-Walk was perceived physical functioning and the secondary outcomes were six-minute walk test distance , health related quality of life , self-care behaviour , self-efficacy and physical activity level . Methods : A multicentre r and omized controlled trial . Participants ( N=132 ) were recruited from three academic hospitals in Sydney , Australia . Participants were r and omized to either the  Home-Heart-Walk group or the control group . Perceived physical functioning , health related quality of life , self-care behaviour , exercise self-efficacy and physical activity level were measured at baseline and at three- and six-month follow-up . Results : After adjusting for baseline scores , there were no statistically significant between-group differences in perceived physical functioning , six-minute walk test distance , health related quality of life and exercise self-efficacy at follow-up . The intervention group had improvement in self-care behaviour ( F(1,129 ) = 4.75 , p = 0.031 ) and physical activity level ( U = 1713 , z = −2.12 , p = 0.034 ) at the six-month follow-up compared with the control group . Conclusion : The Home-Heart-Walk did not improve the perceived physical functioning of the intervention group . Although the feasibility and acceptability of this strategy to support self-monitoring and improve self-care behaviour was demonstrated , self-reported adherence was unreliable ; newer technologies may offer better assessment of adherence Background Nowadays , heart failure ( HF ) related morbidity and mortality rate is increasing globally . Younger population s happen to be more affected by HF in sub- Saharan African than the western countries . Even though medications , low sodium diet , regular exercise , and weight monitoring are essential to control heart failure symptoms and its exacerbation , poor adherence to these self-care recommendations is contributing to an increased in hospitalization , morbidity , and mortality . Therefore , this study aim ed to assess heart failure patients ’ adherence to self-care recommendations and its associated factors . Methods A hospital-based cross-sectional study was conducted on 310 adult heart failure patients attending Gondar University referral hospital from February to May 2017 . The participants were selected by systematic r and om sampling technique . Data were collected through face to face interview and from the patients ’ medical records . The data were analyzed using SPSS version 20 . A binary logistic regression model was used to check the effect of different factors on the patients ’ adherence level . Results Of 310 study participants only 22.3 % ( 95 % CI , 17.4%-26.8 % ) of heart failure patients reported good adherence to their self-care recommendations . Adherence to self-care recommendation was positively associated with being male in gender ( AOR = 2.34 , 95 % CI : 1.18–4.62 ) , good level of heart failure knowledge ( AOR = 2.49 , 95 % CI : 1.276–4.856 ) and free from chronic comorbid diseases ( AOR = 2.57 , 95 % CI : 1.28–5.14 ) . Conclusion Overall , heart failure patients ’ adherence to self-care recommendations is poor and selective . Being male in gender , had no chronic comorbidity , and a good level of heart failure knowledge were positively associated with adherence to self-care recommendations . It is therefore strategic to plan improving heart failure patients ’ knowledge about heart failure signs , symptoms and its management approaches , to improve the patients ’ adherence level The purpose of this study was to determine how an exercise adherence intervention affects the physiological , functional , and quality of life outcomes of patients with heart failure ( HF ) . Sixteen HF patients were r and omly assigned to an  exercise-only group  ( n = 8) or to an  exercise-with-adherence group ( n = 8) . Two of the 16 people  died from nonexercise related causes during the study and were not included in the analysis . The intervention was tested over a 24-week period in which patients participated in a 12-week supervised exercise program ( Phase 1 ) followed by 12 weeks of unsupervised home exercise ( Phase 2 ) . The intervention format was one of individualized graphic feedback on exercise goals and participation and problem-solving support by nurses . Results indicate that patients who received the intervention exercised more frequently and experienced improved outcomes during both phases . The adherence intervention may encourage HF patients to continue to exercise and thereby maintain the health benefits gained in both phases of an exercise program Endothelial dysfunction has been recognized as a pathophysiologic mechanism in the progression of heart failure ( HF ) . However , little attention has been given to the ability of dietary approaches to improve endothelial function . This study examined the effects of the Dietary Approaches to Stop Hypertension ( DASH ) diet on endothelial function , exercise capacity , and quality of life in patients with chronic symptomatic ( stage C ) HF . Forty-eight patients were r and omized to follow the DASH diet ( n = 24 ) or the general HF dietary recommendations ( n = 24 ) . Endothelial function was assessed by measuring large and small arterial elasticity ( LAE and SAE ) at rest . Exercise capacity ( measured with the 6-minute walk test ) and quality of life ( measured with the Minnesota Living with Heart Failure Question naire ) at baseline and 3 months were also evaluated . Patients were older adults with an average HF duration of 5 years .  LAE at 1 month improved significantly in the DASH diet group ( P < 0.01 ) . Overall LAE and SAE scores at 3 months also improved ; however , the net changes were not statistically significant . The DASH group had better exercise capacity ( 292 m vs 197 m ; P = 0.018 ) and quality of life scores ( 21 vs 39 ; P = 0.006 ) over time , while sodium intake levels at 1 , 2 , and 3 months were comparable between the groups . Adhering to the DASH diet improved arterial compliance initially and improved exercise capacity and quality of life scores at 3 months . The DASH diet may be an important adjunctive therapy for patients with symptomatic H Although previous studies have documented adherence with certain established heart failure ( HF ) quality metrics in outpatient cardiology practice s , the extent to which there is conformity with other evidence -based , guideline -driven quality metrics in out patients with HF is unknown . IMPROVE HF is a prospect i ve cohort study design ed to characterize the current management of patients with chronic HF and left ventricular ejection fraction < or=35 % in outpatient cardiology practice s. We evaluated baseline data for conformity with adjunctive HF therapies including pneumococcal vaccinization , hydralazine/isosorbide dinitrate ( HYD/ISDN ) for Black patients , statin therapy , antiplatelet therapy , smoking-cessation counseling , low-density lipoprotein cholesterol levels  ( < 100 mg/dl ) , and  systolic blood pressure decrease  ( all patients < 140 mm Hg or [ optimal ] < 130 mm Hg ) . Baseline data were available for 15,381 patients attending 167 cardiology practice s. Patient characteristics included a median age 70 years , 71.0 % men , 9.1 % Black patients , 65.2 % with ischemic HF cause , and 61.7 % with a history of hypertension .  Mean adherences or documentations of adherence were only 7.3 % for HYD/ISDN and 1.0 % for pneumococcal vaccination .  Adherence to other adjunctive therapies ranged from 27.4 % to 82.0 % but none of the adjunctive treatment interventions were associated with high levels of adherence . Conformity with guideline -recommended , adjunctive HF therapies is deficient in the management of out patients with HF . Critical gaps in documentation or delivery of care exist , especially for the use of pneumococcal vaccination and HYD/ISDN . In conclusion , improved processes of care , better documentation , and /or increased measures to promote adherence to all primary and adjunctive therapies for HF are needed Background Adherence to the Heart Failure Society of America ( HFSA ) 2010 guidelines recommending 30 minutes of supervised moderate intensity exercise five days per week is difficult for patients with heart failure ( HF ) . Innovative programs are needed to assist HF patients to adhere to long-term exercise . The objective of this prospect i ve r and omized two-group repeated measures experimental design is to determine the efficacy of a behavioral exercise training intervention on long-term adherence to exercise at 18 months in patients with heart failure . Methods / Design A sample size of 246 subjects with heart failure will be recruited over a 3 year period . All subjects receive a cardiopulmonary exercise test and 9 supervised exercise training sessions during a 3 week run-in period prior to r and omization . Subjects completing at least 6 of 9 training sessions are r and omized to the HEART Camp Intervention group ( HC ) or to a st and ard care ( SC ) exercise group . The HC intervention group receives cognitive-behavioral strategies that address the intervention components of knowledge , attitudes , self-efficacy , behavioral self-management skills and social support . The SC group is provided access to the exercise facility and regular facility staff for the 18 month study period . The primary aim is to evaluate the effect of HEART Camp on adherence to exercise , with our central hypothesis that the HC group will have significantly better adherence to exercise at 18 months . Secondary aims include evaluating which components of the  HEART Camp intervention mediate the effects of the intervention on adherence ; evaluating the effect of HEART Camp on specific health outcomes ; exploring selected demographic variables ( race , gender , age ) as potential moderators of the effect of the HEART Camp  intervention on adherence ; and exploring the perceptions and experiences that context ualize exercise adherence . Discussion The HEART Camp intervention is the first to test a multi-component intervention design ed to improve long-term adherence to exercise behavior in patients with HF . Improving long-term adherence to exercise is the logical first step to ensure the required dose of exercise that is necessary to realize beneficial health outcomes and reduce costs in this burdensome chronic illness . Trial registration Clincaltrials.gov NCT01658670 Background Frequent rehospitalisations and poorer survival chances in heart failure ( HF ) patients may partly be explained by poor medication adherence . There are multiple medication-related reasons for suboptimal adherence , but psychological reasons may also be important . A novel TELEmonitoring device may improve MEDication adherence in HF patients ( TELEMED-HF ) . TELEMED-HF is a r and omized , controlled clinical intervention trial design ed to examine ( 1 ) the efficacy and cost-efficiency of an electronic medication adherence support system in improving and monitoring HF patients ' medication adherence ; ( 2 ) the effect of medication adherence on hospitalizations and health care consumption ; as well as on ( 3 ) clinical characteristics , and Quality of Life ( QoL ) ; and ( 4 ) clinical , sociodemographic , and psychological determinants of medication adherence . Methods / Design Consecutive patients with chronic , systolic HF presenting to the outpatient clinic of the TweeSteden Hospital , The Netherl and s , will be approached for study participation and r and omly assigned ( 1:1 ) following blocked r and omization procedures to the intervention ( n = 200 ) or usual care arm ( n = 200 ) . Patients in the intervention arm use the medication support device for six months in addition to usual care . Post-intervention , patients return to usual care only and all patients participate in four follow-up occasions over 12 months . Primary endpoints comprise objective and subjective medication adherence , healthcare consumption , number of hospitalizations , and cost-effectiveness . Secondary endpoints include disease severity , physical functioning , and QoL. Discussion The TELEMED-HF study will provide us a comprehensive underst and ing of medication adherence in HF patients , and will show whether telemonitoring is effective and cost-efficient in improving adherence and preventing hospitalization in HF patients .Trial registration numberNCT01347528 BACKGROUND Currently , fluid restriction recommendations in heart failure ( HF ) are based on expert opinion . After implementing a 1,000-mL/d fluid restriction for 60 days after discharge , outcomes were examined . METHODS AND RESULTS In a r and omized controlled design , hyponatremic patients ( serum sodium ≤137 mg/dL ) received usual care ( UC ; n = 26 ) or 1,000 mL/d fluid restriction ( n = 20 ) at discharge . Quality of life ( QoL ) , thirst , difficulty following fluid recommendations , adherence to fluid restriction , HF emergency care , HF rehospitalization , and all-cause death were examined . Mean age was 62.8 ± 12.8 years ; 46 % were white . There were no differences by group in baseline demographics , comorbidities , and QoL , except that more UC patients had New York Heart Association ( NYHA ) functional class III/IV status ( P = .019 ) . Median [ interquartile range ] QoL scores were better in the 1,000 mL/d group for symptom burden ( 83.3 [ 68.8 - 91.7 ] vs 50 [ 29.2 - 79.2 ] ; P = .018 ) , total symptoms ( 77.1 [ 58.1 - 91.7 ] vs 54.2 [ 30.2 - 73.9 ] ; P = .022 ) , overall QoL summary ( 72.6 [ 52.2 - 86.3 ] vs 51.0 [ 37.7 - 68.5 ] ; P = .038 ) , and clinical QoL summary ( 75.5 [ 57.8 - 92.9 ] vs 59.1 [ 35.7 - 77.3 ] ; P = .039 ) . There were no group differences in thirst , difficulty adhering to fluid recommendations , adherence to fluid restriction , or health care consumption . CONCLUSIONS The 1,000 mL/d fluid restriction led to improved QoL at 60 days after discharge . Future research in a larger more heterogeneous sample is needed Background Type D ( distressed ) personality and medication nonadherence have been associated with poor health outcomes . Type D personality is associated with poor medication adherence in patients with coronary artery disease . However , the relationship between type D personality and medication adherence in patients with heart failure ( HF ) remains unknown . Purpose Therefore , the goal of this study was to examine the association between type D personality and medication adherence in patients with HF . Method This was a sub- analysis of baseline data from a r and omized controlled trial with 84 patients with HF in the USA .  Demographic , clinical , and psychological data were collected at baseline by interview , question naires , and medical record review . Type D personality was assessed using the Type D Personality Scale ( DS14 ) . Medication adherence was measured using both objective  ( Medication Event Monitoring System , MEMS )  and self-reported ( Morisky Medication Adherence Scale , MMAS-4 ) measures . Patients started medication adherence monitoring with the MEMS bottle at baseline and is used continuously for a month . Multiple regressions were used to explore the relationships between type D personality and medication adherence while adjusting for demographic , clinical , and psychological factors . Results Patients with type D personality were more likely to have poor medication adherence . Type D personality was associated with medication adherence before and after adjusting for covariates when it was analyzed as a categorical variable . However , type D personality was not associated with medication adherence when analyzed as a dimensional construct . Negative affectivity , a component of type D personality , was associated with medication adherence . Conclusion As a dimensional construct , type D personality may not reflect the components of the personality associated with poor outcomes . Negative affectivity was associated with medication adherence in patients with HF . Interventions aim ing to improving/enhancing medication adherence need to take into account patients with the negative affectivity component of type D personality who are at higher risk for poor medication adherence , which may lead to adverse health outcomes Aims Exercise is known to be beneficial for patients with heart failure ( HF ) , and these patients should therefore be routinely advised to exercise and to be or to become physically active . Despite the beneficial effects of exercise such as improved functional capacity and favourable clinical outcomes , the level of daily physical activity in most patients with HF is low . Exergaming may be a promising new approach to increase the physical activity of patients with HF at home . The aim of this study is to determine the effectiveness of the structured introduction and access to a Wii game computer in patients with HF to improve exercise capacity and level of daily physical activity , to decrease healthcare re source use , and to improve self‐care and health‐related quality of life . Methods and results A multicentre r and omized controlled study with two treatment groups will include 600 patients with HF . In each centre , patients will be r and omized to either motivational support only ( control ) or structured access to a Wii game computer ( Wii ) . Patients in the  control  group will receive advice on physical activity and will be contacted by four telephone calls . Patients in the Wii group also will receive advice on physical activity along with a Wii game computer , with instructions and training . The primary endpoint will be exercise capacity at 3 months as measured by the 6 min walk test . Secondary endpoints include exercise capacity at 6 and 12 months , level of daily physical activity , muscle function , health‐related quality of life , and hospitalization or death during the 12 months follow‐up . Conclusion The HF‐Wii study is a r and omized study that will evaluate the effect of exergaming in patients with HF . The findings can be useful to healthcare professionals and improve our underst and ing of the potential role of exergaming in the treatment and management of patients with HF . Trial registration BACKGROUND Heart failure ( HF ) is increasing in prevalence and is associated with prolonged morbidity , repeat hospitalizations , and high costs . Drug therapies and lifestyle changes can reduce hospitalizations , but nonadherence is high , ranging from 30 % to 80 % . There is an urgent need to identify cost-effective ways to improve adherence and reduce hospitalizations . TRIAL DESIGN The Heart Failure Adherence and Retention Trial ( HART ) evaluated the benefit of patient self-management ( SM ) skills training in combination with HF education , over HF education alone , on the composite end points of death/HF hospitalizations and death/all-cause hospitalizations in patients with mild to moderate systolic or diastolic dysfunction . Secondary end points included progression of HF , quality of life , adherence to drug and lifestyle regimens , and psychosocial function . The HART cohort was composed of 902 patients including 47 % women , 40 % minorities , and 23 % with diastolic dysfunction . After a baseline examination , patients were r and omized to SM or education control , received 18 treatment contacts over 1 year , annual follow-ups , and 3-month phone calls to assess primary end points . Self-management treatment was conducted in small groups and aim ed to activate the patient to implement HF education through training in problem-solving and 5 SM skills . The education control received HF education in the mail followed by a phone call to check comprehension . CONCLUSIONS The significance of HART lies in its ability to determine the clinical value of activating the patient to collaborate in his or her care . Support for the trial hypotheses would encourage interdisciplinary HF treatment , drawing on an evidence base not only from medicine but also from behavioral medicine We conducted a feasibility study of a telehealth intervention ( an electronic pill box ) and an m-health intervention ( an app on a smartphone ) for improving medication adherence in older adults with heart failure . A secondary aim was to compare patient acceptance of the devices . The participants were 60 adults with HF ( 65 % male ) . Their average age was 69 years and 83 % were Caucasian . Patients were r and omized using a 2 × 2 design to one of four groups : pillbox silent , pillbox reminding , smartphone silent , smartphone reminding . We examined adherence to 4 medications over 28 days . The overall adherence rate was 78 % ( SD 35 ) . People with the telehealth device adhered 80 % of the time and people with the smartphone adhered 76 % of the time . Those who received reminders adhered 79 % of the time , and those with passive medication reminder devices adhered 78 % of the time , i.e. reminding did not improve adherence . Patients preferred the m-health approach . Future interventions may need to address other contributors to poor adherence such as motivation Abstract Clinical systolic heart failure ( HF ) guidelines specify recommendations for ACE inhibitors ( ACEI ) , angiotensin receptor blockers ( ARB ) , and beta blockers according to doses used in clinical trials . However , many HF patients remain suboptimally treated . We sought to determine which provider type , between an interprofessional HF team , non-HF cardiologists , and primary care physicians ( PCP ) , most optimally manages HF medications and doses . A retrospective chart review was performed on adult patients at an academic county hospital with an ejection fraction ≤40 % and a diagnosis of HF , seen by a single provider type ( HF team , cardiologist , or PCP ) at least twice within a 12-month period .  Utilization rates of any ACEI/ARB and any beta blocker were robust across provider types , though evidence -based ACEI/ARB and beta blocker were greatest from the HF team . Doses of evidence -based therapies dropped markedly in the non-HF team groups . The percent of patients prescribed optimal doses of an evidence -based ACEI/ARB AND beta blocker was 69 % , 33 % , and 25 % for the HF team , cardiologists and PCPs , respectively ( p < 0.0167 ) . Patients followed by the HF team were more frequently prescribed evidence -based medications at optimal doses . This supports using specialized interprofessional HF teams to attain greater adherence to evidence -based recommendations in treating systolic HF
Positive outcomes occurred in the short-term from interventions using approaches such as  exercise prescriptions , goal setting , feedback and problem-solving .
However , longer-term maintenance of exercise  was less successful .
Physical activity is recommended for people with stable heart failure ( HF ) , because it is known to improve quality of life and health outcomes .
However , adherence to this recommendation has been poor in many studies .
A systematic review was conducted to examine the effectiveness of strategies used to promote exercise adherence in those with HF .