Medication Adherence Mediates the Relationship Between Heart Failure Symptoms and Cardiac Event-Free Survival in Patients With Heart Failure.

Heart failure symptoms were measured once at baseline with a single yes/no question, so the full symptom burden, duration, severity, and distress were not captured. Only one heart failure medication was monitored, although the authors cite prior work suggesting one medication may reflect overall adherence. Patients were younger than heart failure patients in general, and many were recruited from outpatient settings, so results may not apply to older or hospitalized patients. The analysis combined two prospective studies from different time periods, which may introduce bias. Mediation was tested statistically and the authors call the findings exploratory, so it does not show that improving adherence causes fewer cardiac events.

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Do not conclude that a medication-adherence programme will reduce cardiac hospitalization or death. This was an observational analysis, not a trial of an adherence intervention, and the authors call the mediation finding exploratory.