Improve Heart Failure Treatment Adherence with Spirituality


By John M. de Castro, Ph.D.


“Given the mechanism by which we think religion/spirituality influences physical health, i.e., through psychosocial and behavioral pathways, and the strong influence that psychosocial and behavioral factors have on risk of developing cardiovascular disease, there is no medical condition that R/S is more likely to influence than CVD.” – Fernando A. Lucchese


Cardiovascular disease is the number one killer, claiming more lives than all forms of cancer combined. “Heart disease is the leading cause of death for both men and women. About 610,000 people die of heart disease in the United States every year–that’s 1 in every 4 deaths. Every year about 735,000 Americans have a heart attack.” – Centers for Disease Control.


A myriad of treatments has been developed for heart disease including a variety of surgical procedures and medications. In addition, lifestyle changes have proved to be effective including quitting smoking, weight reduction, improved diet, physical activity, and reducing stresses. Contemplative practices, such as meditation, tai chi, and yoga, have also been shown to be helpful for heart health. In addition, mindfulness practices have also been shown to be helpful for producing the kinds of other lifestyle changes needed such as smoking cessation, weight reduction, and stress reduction. Mindfulness has also been shown to be linked to spirituality and

Spirituality and religiosity are known to help with a wide range of physical and psychological problems. So, it would make sense to investigate the relationship of spirituality and religiosity to recovery from heart failure.


In today’s Research News article “Association between Spirituality and Adherence to Management in Outpatients with Heart Failure.” See:

or see summary below or view the full text of the study at:

Alvarez and colleagues measured adherence to therapy, quality of life, depression, religiosity and spirituality in adult patients with heart failure. They found that there were significant relationships between spirituality and adherence to pharmacologic and non-pharmacologic therapy, such that the higher the spirituality of the patient the greater the adherence. This was true for all of the spirituality subscales including spiritual connection, meaning of life, awe and wonder, wholeness & integration, spiritual strength, inner peace, hope & optimism and faith and was also true for intrinsic religiosity but not overall religiosity. They also found that the higher the levels of spirituality the higher the quality of life, both overall and disease specific, and the lower the depression.


It should be pointed out that these results are correlational and as such causation cannot be concluded. It could be that the kinds of people who tend to adhere to medical recommendations are also the kinds of people who pursue spirituality. It will take a study where spirituality is manipulated to establish a causal connection.


These findings indicate that spirituality has very positive relationships with adherence and quality of life and negative relationship to depression in heart failure patients. Adherence is particularly significant. One of the biggest challenges in all of medicine is to get patients to actually take the prescribed medications, perform the recommended life style changes, and participate in the prescribed therapy sessions. So, increasing adherence is very important for increasing the likelihood of patients getting the full benefit of their medical recommendations. For heart failure patients this could literally be the difference between life and death. These findings, like many others, point to the importance of spirituality and intrinsic religiosity, but not simple participation in religion, in the health and well-being of the individual.


So, improve heart failure treatment adherence with spirituality.


“the link between improved health and spiritual wellbeing was at least partially explained by the role gratitude plays in spirituality. It seems that a more grateful heart is indeed a more healthy heart. Gratitude journaling is an easy way to support cardiac health.” –  Paul Mills


CMCS – Center for Mindfulness and Contemplative Studies


This and other Contemplative Studies posts are also available on Google+


Study Summary

Alvarez, J. S., Goldraich, L. A., Nunes, A. H., Zandavalli, M. C. B., Zandavalli, R. B., Belli, K. C., … Clausell, N. (2016). Association between Spirituality and Adherence to Management in Outpatients with Heart Failure. Arquivos Brasileiros de Cardiologia, 106(6), 491–501.



Background: Spirituality may influence how patients cope with their illness.

Objectives: We assessed whether spirituality may influence adherence to management of outpatients with heart failure.

Methods: Cross sectional study enrolling consecutive ambulatory heart failure patients in whom adherence to multidisciplinary treatment was evaluated. Patients were assessed for quality of life, depression, religiosity and spirituality utilizing validated questionnaires. Correlations between adherence and psychosocial variables of interest were obtained. Logistic regression models explored independent predictors of adherence.

Results: One hundred and thirty patients (age 60 ± 13 years; 67% male) were interviewed. Adequate adherence score was observed in 38.5% of the patients. Neither depression nor religiosity was correlated to adherence, when assessed separately. Interestingly, spirituality, when assessed by both total score sum (r = 0.26; p = 0.003) and by all specific domains, was positively correlated to adherence. Finally, the combination of spirituality, religiosity and personal beliefs was an independent predictor of adherence when adjusted for demographics, clinical characteristics and psychosocial instruments.

Conclusion: Spirituality, religiosity and personal beliefs were the only variables consistently associated with compliance to medication in a cohort of outpatients with heart failure. Our data suggest that adequately addressing these aspects on patient’s care may lead to an improvement in adherence patterns in the complex heart failure management.


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