The relationship between spiritual well-being, quality of life and medication adherence in patients with heart failure: A prospective observational study

Introduction: Spiritual well-being (SWB) has been increasingly recognized as a key factor in the management of chronic and terminal illnesses. It may affect psychological and physical symptoms and influence both quality of life (QoL) and medication adherence. However, in the context of heart failure (HF) the associations between these variables remain unexplored. This study aims to investigate the relationship between SWB, QoL and medication adherence in patients hospitalized for symptomatic HF. The primary objective is to evaluate whether SWB assessed during hospitalization is associated with QoL and, secondary, with medication adherence one month after discharge. Methods and results: This is a prospective observational study involving adult patients admitted to the Cardiology Department of the University Hospital of Padua (Italy) with a diagnosis of symptomatic HF. SWB was measured during hospitalization using the “Functional Assessment of Chronic Illness Therapy – Spiritual Well-Being 12-item Scale” (FACIT-Sp-12). One month after discharge, participants completed the “EuroQol 5 Dimensions 5 Levels” (EQ-5D-5L) to assess QoL and the “Morisky Medication Adherence 8-item Scale” (MMAS-8) to evaluate adherence. Among 43 participants (mean age 62.3 years; 76.7% male), the mean FACIT-Sp-12 score was 29.9 (SD = 7.5). At follow-up (n = 20), FACIT-Sp-12 showed a moderate, non-significant correlation with EQ-VAS (rho = 0.383; p = 0.096) and a weak positive correlation with EQ-5D-5L (rho = 0.259; p = 0.270). Regression analyses found a significant association between the Peace subscale and EQ-VAS (β = 5.97; p = 0.009), while the FACIT-Sp-12 total score showed a positive trend (β = 1.06; p = 0.064). No significant associations were observed with MMAS-8 adherence. Conclusion: Identifying the potential role of SWB in enhancing QoL may support a more person-centred approach to HF care and highlight the value of integrating spiritual assessments into routine clinical practice