Clinical, psycho-social and treatment compliance in a group of patients with alcoholic dilated cardiomyopathy

Introduction: Patients with alcoholic dilated cardio-miopathy (DCM) represents a populational group with major medical, social and legal problems in Romania. It is recognised the fact that stigma of alcohol addiction determines underdiagnosis of consecutive pathologi-cal conditions (by individuals’ restraint to accept their psychological issue and to search for medical help) and undertreatment explained by a perception of non-com-pliance on long term by medical staff.

Objective: To analyse clinical and biological aspects on patients with alcoholic DCM and also the quality of life and therapeutic compliance of these people.

Methods: We analysed data of 70 patients diagnosed with alcoholic DCM, recorded retrospectively and ob-servationaly from the archive of University Emergency Hospital of Bucharest from Cardiology 1 and 2 depart-ments, on a 10 years period. Patients with any other DCM ethiologies not implying substantial alcohol con-sumption were excluded. Clinical and paraclinical data were obtained from patients’ medical files. A psycho-social, life quality and therapeutic compliance questi-onnaire was adressed by direct individualized phone contact, with patients’ accept.

Results: Most frequent admissions due to alcoho-lic DCM were in the 51-60 years decade (37%; 96% of patients were males and 61% living in rural places. Cardiovascular risk factors associated were: smoking (91%), obesity (77%), dislipidemia (68%) and diabetes (63%). Atrial fibrillation was the most common cardi-ac disease associated (31%) followed by hypertension (28%) and 7% had myocardial infarction sequelae. On echocardiography, 71% had severe systolic dysfunction with ejection fraction nd 80% had severe mitral regurgitation. Mean NT-proBNP value at admission was 4196 pg/ml. Psychiatric examination diagnosed major depression in 29%, anxious disease (23%) and cognitive disease installed in 19%. 38 patients answered to phone questionnaire, the rest being found dead (8), not contacted or refusing the investigation. 84% con-tinued alcohol consumption despite history of 2 to 6 admissions due to disease. 89% declared their income as unsatisfactory and among determining factors of drinking were mentionedthe entourage (28%), stress (22%), personal problems (17%), pleasure (17%), lone-liness (11%) and familial habits (6%).

Conclusions: Patients with alcoholic DCM, even trea-ted according to current guidelines in heart failure, have a negative outcome, if maintaining alcohol use and methods used to control this addiction are insuffi-cient. It is necessary to give special attention to psychi-atric evaluation of these patients and, also, introducing social investigations and initiating programs of strictly regulated detoxification. Rehabilitation and social-pro-fessional reinsertion could be useful choices for these individuals and in this context, implication of entoura-ge and family plays an important role.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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