Factors that influence adherence to medication in adults with congenital heart disease (ACHD).
Open accessAbstract
Objective: Innovative operative and interventional procedures have improved survival in congenital heart disease (CHD), and today more than 90% of these children reach adulthood. Consequently, adherence and psychosocial issues are becoming increasingly important because non-adherence to treatment recommendations worsens morbidity and mortality. This study aimed to identify factors modifying adherence to medication in adult congenital heart disease (ACHD). Methods: This cross-sectional study included 451 outpatients (female 47.9%, average age ± SD: 37.9 ± 12 years) from the ACHD department, who completed a questionnaire assessing medication non-adherence and individual barriers to treatment. Further assessments included psychological well-being (Hospital Anxiety and Depression scale; HADS), childhood traumatization, sociodemographic, and clinical data. Binary logistic regression analysis calculated the impact of these factors on drug adherence. Results: Of the 451 patients 162 participants (35.9%) reported to be non-adherent. In univariate analysis non-adherence to treatment was associated with smoking ( P = < 0.001) and internet addiction ( P = 0.005). Further factors negatively influencing adherence were the presence of depressive symptoms ( P = 0.002), anxiety ( P = 0.004), and childhood traumatization ( p = 0.002). Factors positively associated with adherence were older age ( P = 0.003) and more advanced heart disease as indicated by NYHA class ( P = 0.01), elevated NT-proBNP ( P = 0.02), device therapy ( P = 0.002) and intermittent arrhythmias ( P = 0.01). In multivariate analysis especially psychopathological factors such as depression ( P = 0.009), anxiety ( P = 0.032) and childhood traumatization ( P = 0.006) predicted non-adherence. Conclusion: Adherence is a critical issue in the long-term management of ACHD. Identifying modifiable factors that worsen adherence offers the opportunity for targeted interventions. Depressive symptoms, anxiety, and adverse childhood experiences are amenable to psychosocial interventions, as well as cigarette smoking. Our study suggests that a multimodal and interdisciplinary treatment concept for the long-term management of adults with congenital heart disease could be beneficial. Whether it will further improve morbidity and mortality, should be assessed in prospective interventions.
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Psychiatric symptoms and illnesses are associated with worse outcomes regarding the CVD, including poorer prognosis, lower quality of life, increased risk of mortality, and interference with CVD treatment.
“Psychiatric symptoms and illnesses are in turn associated with several worse outcomes regarding the CVD: poorer prognosis of the course of the CVD, lower quality of life (QoL), increased risk of mortality, and interference with the CVD treatment, for example, due to worse adherence (3, 7–11).”
From Metacognitive Short-Term Intervention in Patients With Mental Disorders Following Cardiovascular Events (2022) · cites this paper as [11]
The Results (Predictors of (Non)-adherence in Multivariate Analysis; page unavailable) associate depressive symptoms and anxiety with medication non-adherence in adults with congenital heart disease, supporting the treatment-adherence part of the claim. The cited passages do not establish poorer CVD prognosis, lower quality of life, or increased mortality; the Abstract says whether interventions improve morbidity and mortality remains to be assessed. (LLM, conf=0.88)
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- Authors
- Halling, T., Akkermann, S., Löffler, F., Groh, A., Heitland, I., Haefeli, W. E., Bauersachs, J., Kahl, K. G., & Westhoff-Bleck, M.
- Affiliations
- Medizinische Hochschule Hannover (DE)
- University Hospital Heidelberg (DE)
- Corresponding author
- Kahl, Kai G.
- Venue
- Frontiers in Psychiatry
- Publisher
- Frontiers Media SA
- Published
- 2021-11-24
- Volume
- 12
- Pages
- 788013-788013
- ISSN
- 1664-0640 (ISSN-L)
- PMC
- PMC8660073
- OpenAlex
- W4200147327
- Cited by
- 23
- References
- 41
- Citations by year
- 2026: 4 · 2025: 6 · 2024: 5 · 2023: 4 · 2022: 4
- FWCI
- 3.55
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Family Practice › Medication Adherence and Compliance
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Health Professions › Speech and Hearing › Adolescent and Pediatric Healthcare
- Keywords
- medication adherence, adult congenital heart disease, medication non-adherence, depression, anxiety, childhood trauma, adverse childhood experiences, smoking, internet addiction, psychosocial factors, NYHA functional class, NT-proBNP, device therapy, long-term management
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