HF patients less likely to follow treatment advice if they’re lonely

Less than 10% of heart failure (HF) patients comply with physicians’ advice on salt and fluid restrictions, daily weigh-ins and physical activity, according to research presented at this year’s European Society of Cardiology Heart Failure conference in Athens, Greece. Loneliness, above all else, was an independent predictor of whether patients stuck to their doctors’ guidelines.

Senior author Beata Jankowska-Polaska, a professor at Wroclaw Medical University in Poland, and her colleagues recruited 475 chronic HF patients for their study, all of whom were instructed to limit their salt and fluid intake, exercise regularly and weigh themselves for fluid retention to optimize their quality of life. In line with the Revised Heart Failure Compliance Scale, patients reported they weighed in either “every day” or “three times a week” and followed recommendations for salt and fluid intake and exercise “most of the time” or “all of the time.”

While 58% of the study population said they complied with their medication and regular physical check-ups, just 7% followed all four non-drug recommendations, Jankowska-Polaska and her team said. Almost 48% reported no physical activity and 19% said they exercised “rarely,” and 25% and 17% never or very rarely adhered to fluid restrictions, respectively.

An additional 13% of patients said they never restricted salt intake, and 22% said they did so very rarely. Fifty-four percent weighed themselves less than once a week; 17% said their weigh-ins were weekly.

“It is worrying that fewer than one in ten patients observed all of the lifestyle advice,” Jankowska-Polaska said in a release. “We also found that women were less compliant than men, and patients over 65 had poorer scores than younger patients.”

Jankowska-Polaska said loneliness, a higher number of comorbidities and more physically limited HF were independent risk factors for non-compliance, but loneliness was the most pronounced. She said doctors need to encourage better self-care in HF patients, especially those who have to manage extensive medication regimens and lifestyle shifts without the help of close friends or family members.

“Loneliness is the most important predictor of whether patients adopt the advice or not,” she said. “Patients who are alone do worse in all areas. Family members have a central role in helping patients comply, particularly older patients, by providing emotional support, practical assistance and advice.”