Burden of Treatment in Patients With Heart Failure

BACKGROUND: Heart failure self-care can contribute to a high daily workload and treatment burden. The goal of this cohort study was to assess the characteristics and outcomes associated with burden of treatment (BoT). METHODS: Surveys comprising validated instruments to measure BoT and other constructs were mailed to patients with heart failure in Southeastern Minnesota. Participants were divided into tertiles by BoT scores. Associations of clinical variables with BoT were examined using multinomial logistic regression. Associations of BoT with mortality and hospitalizations were examined using Cox proportional hazard regression and Andersen-Gill models, respectively. RESULTS: A total of 609 participants (mean age 76.3 years, 60.3% men, 55.2% urban, 64.3% preserved ejection fraction) completed surveys. Higher BoT was associated with worse health status, more depressive symptoms, lower resilience, less social support, lower medication adherence, and worse health literacy. Mean±SD follow-up was 14.4 (4.1) months. Estimated 1-year mortality (8.3% [95% CI, 4.3%-12.1%], 11.0% [95% CI, 6.5%-15.2%], 16.0% [95% CI, 10.8%-21.0%]) and 1-year mean cumulative hospitalizations (0.57 [95% CI, 0.45-0.72], 0.83 [95% CI, 0.66-1.05], 1.15 [95% CI, 0.93-1.42]) increased across patients reporting low, medium, and high BoT, respectively. Adjustment for health status eliminated any significant association of BoT with risks of death and hospitalization (adjusted hazard ratio [HR], 1.10 [95% CI, 0.58-2.07] and 1.09 [95% CI, 0.74-1.61], respectively, highest versus lowest BoT tertile). CONCLUSIONS: BoT in heart failure varies by clinical and psychosocial factors. Higher BoT identifies patients at increased risk of adverse health outcomes due to their worse health status. These findings can serve as a foundation for interventions to minimize workload and improve quality of life.