Interest in healthy lifestyle and adherence to medications: Impact on mortality among elderly cardiovascular patients in the DEBATE Study

ObjectiveWe examined how a patient-centered consultation can help the physician to evaluate older patients’ adherence to medical care and a healthy lifestyle. We hypothesised that an accurate estimate of adherence should be shown in their prognosis.MethodsCardiovascular patients (>74 years) in an intervention study (the DEBATE Study) were divided according to physician's clinical impression: (1) “Active adherents” (N = 53): those having a healthy lifestyle and adherent to medications. (2) “Passive adherents” (N = 65): those not showing any particular interest in a healthy lifestyle but adherent to medications. (3) “Interested scepticals” (N = 66): those showing an interest in a healthy lifestyle but feeling sceptical about medications. (4) “Passive non-adherents” (N = 15): those having a sedentary lifestyle and non-adherence to medical treatments. The combined endpoint was permanent institutionalisation or death during the average 4.5-year follow-up.ResultsMortality during the 4.5-year follow-up ranged among groups 1–4: 15, 19, 26, and 53% (p = 0.01), and the proportions permanently institutionalised 0, 2, 6, and 20% (p = 0.003). Multivariate analyses with age, gender, Charlson comorbidity index, dependence in ADL activities and with group 1 as the reference (1.0) showed that both group 3 (HR 2.73, 95% CI 1.11–6.52) and group 4 (HR 6.24, 95% CI 1.88–20.67) were at significantly increased risk for institutionalisation or death.ConclusionIn a patient-centered consultation adherence can be accurately evaluated, and such an evaluation is of significant value in the prognosis of older cardiovascular patients.Practice implicationsA patient's expression of attitudes towards medications and healthy lifestyle may be elicited in a patient-centered consultation. This patient-centered approach may help in modifying care to support appropriate, tailored treatments for individual patients.