Lonely patients with heart failure least likely to follow treatment recommendations

Less than 10% of heart failure patients comply with advice on salt and fluid restrictions, daily weighing, and physical activity, reports a study presented today at Heart Failure 2019, a scientific congress of the European Society of Cardiology (ESC).

"Loneliness is the most important predictor of whether patients adopt the advice or not," said senior author Professor Beata Jankowska-Polaska, of Wroclaw Medical University, Poland. "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."

Failure to adhere to lifestyle recommendations or regularly take medications contributes to worsening heart failure symptoms and a raised risk of hospitalisation. Breathlessness, swollen ankles and legs, and tiredness occur because the heart can no longer pump effectively. Fluid backs up in the lungs and is retained in parts of the body, and the muscles receive insufficient blood and oxygen.

Daily weighing flags up worsening fluid retention, while salt and fluid restrictions help keep fluid retention under control. Physical activity improves energy levels and quality of life. This study examined adherence to these four recommendations in 475 patients with chronic heart failure using the Revised Heart Failure Compliance Scale.

Following the recommendations was defined as "every day" or "three times a week" for weighing and "most of the time" or "all the time" for salt, fluid, and exercise. Just 7% of patients followed all four non-drug recommendations. Compliance with medication and regular check-ups was higher, at 58%.

Nearly 48% did no physical activity, and 19% very rarely exercised. Some 25% and 17% never or very rarely adhered to fluid restrictions, respectively. While 13% never and 22% very rarely restricted salt intake. More than half of patients (54%) weighed themselves less than once a week, and 17% did it once a week.

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

Multivariate analysis showed that loneliness, higher number of comorbidities, and more physically limiting heart failure were independent predictors of non-compliance to the four recommendations.

Study author Natalia Świątoniowska said: "Patients with comorbid conditions may find it difficult to understand and follow all of the medical advice. For example those with heart failure and kidney disease have more than ten pills to take and some guidance may appear to be conflicting."

Doctors and nurses need to encourage better self-care in their patients with heart failure, said Professor Jankowska-Polańska. "Patients need clear written instructions on how to exercise for example, while text messages or phone calls can be used as reminders. It's important to check that patients understand the advice, tailor the recommendations, and assess adherence at every visit," she said.

Patients with heart failure can lead a normal social life, noted Ms Świątoniowska, provided friends and family accept their dietary restrictions. "It can be difficult for patients with heart failure to stick to the lifestyle advice. Family members in particular have a big influence and it's a good idea to involve them with meal preparation, physical activity, and reminders to check weight."