MEDICATION ADHERENCE IN POST MYOCARDIAL INFARCTION PATIENTS

Authors

  • Saba Hussain NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE
  • Syed Zahid Jamal NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE
  • Faisal Qadir NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE

Abstract

Background: Medication non-adherence after acute myocardial infarction is a global problem causing increased morbidity and mortality. This multifaceted problem has not been well studied in our part of the world. Our study aimed to determine the burden of medication non-adherence in post myocardial infarction patients. Methods: This cross-sectional study was conducted at National Institute of Cardiovascular disease, Karachi, from December 2016 to June 2017. A total of 350 patients were included at the time of discharge after their first myocardial infarction (MI) of which follow up was completed for 315 patients. Baseline characteristics and discharged drug data were collected for each individual. Patients were called at 7th day, 1 and 3months post discharge and were assessed for the medication adherence using Morisky medication adherence scale. They were stratified accordingly into self-reported high, moderate and low groups. Chi- square test was used to determine significant relationship between variables. The level of significance was set at level of p value ≤0.05. Results: Among 315 patients, only 45% patients were adherent to prescribed drugs at 7th day follow up and the adherence further reduces to 19% at 3rd post MI month (p-value <0.001). High income, male gender, and presence of partner persistently showed significantly higher medication adherence. Factors like younger age, addiction and advance education showed higher adherence only in early follow up periods. However, presence of comorbidities, intervention and specific diagnosis had no significant impact. The most common stated reasons for non-adherence were forgetfulness and poor understanding of drugs. Conclusion: Adherence to prescribed medication in post myocardial infarction patients was found to be strikingly suboptimal, contributed by multiple factors. Modification of these factors would likely improve patient adherence to medication and eventually long-term outcome. Keywords: Acute myocardial infarction; Medication adherence

Author Biographies

Saba Hussain, NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE

SENIOR REGISTRARNON-INVASIVE CARDIOLOGYNATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE KARACHI

Syed Zahid Jamal, NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE

PROFESSOR OF  CARDIOLOGYNATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE KARACHI

Faisal Qadir, NATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE

ASSOCIATE PROFESSOR OF  CARDIOLOGYNATIONAL INSTITUTE OF CARDIOVASCULAR DISEASE KARACHI

References

Turin TC, Shahana N, Wangchuk LZ, Specogna AV, Al Mamun M, Khan MA, et al. Burden of cardio-and cerebro-vascular diseases and the conventional risk factors in South Asian population. Glob Heart 2013;8(2):121–30.

Jafar TH, Jafary FH, Jessani S, Chaturvedi N. Heart disease epidemic in Pakistan: women and men at equal risk. Am Heart J 2005;150(2):221–6.

WHO. Noncommunicable diseases country profiles. 2014.

Hall SL, Lorenc T. Secondary prevention of coronary artery disease. Am Fam Physician 2010;81(3):289–96.

Smith SC Jr, Benjamin EJ, Bonow RO, Braun LT, Creager MA, Franklin BA, et al. AHA/ACCF secondary prevention and risk reduction therapy for patients with coronary and other atherosclerotic vascular disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation 2011;124(22):2458–73.

Wald NJ, Law MR. Strategy to reduce cardiovascular disease by more than 80%. BMJ 2003;326(7404):1419.

Mathews R, Peterson ED, Honeycutt E, Chin CT, Effron MB, Zettler M, et al. Early medication nonadherence after acute myocardial infarction: insights into actionable opportunities from the treatment with ADP receptor inhibitors: Longitudinal assessment of treatment patterns and events after acute coronary syndrome (TRANSLATE-ACS) study. Circ Cardiovasc Qual Outcomes 2015;8(4):347–56.

Gonarkar SB, Dhande PP. Medication adherence and its determinants in myocardial infarction patients: An Indian scenario. J Clin Prev Cardiol 2016;5(1):2–8.

Crowley MJ, Zullig LL, Shah BR, Shaw RJ, Lindquist JH, Peterson ED, et al. Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors. J Gen Intern Med 2015;30(1):83–90.

Choudhry NK, Winkelmayer WC. Medication adherence after myocardial infarction: A long way left to go. J Gen Intern Med 2008;23(2):216–8.

DiMatteo MR. Variations in patients’ adherence to medical recommendations: a quantitative review of 50 years of research. Med Care 2004;42(3):200–9.

Choudhry NK, Glynn RJ, Avorn J, Lee JL, Brennan TA, Reisman L, et al. Untangling the relationship between medication adherence and post–myocardial infarction outcomes: medication adherence and clinical outcomes. Am Heart J 2014;167(1):51–8.

Bitton A, Choudhry NK, Matlin OS, Swanton K, Shrank WH. The impact of medication adherence on coronary artery disease costs and outcomes: a systematic review. Am J Med 2013;126(4):357–e7.

Kolandaivelu K, Leiden BB, O'Gara PT, Bhatt DL. Non-adherence to cardiovascular medications. Eur Heart J 2014;35(46):3267–76.

Morisky DE, Ang A, Krousel‐Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens (Greenwich) 2008;10(5):348–54.

Sanfélix-Gimeno G, Peiró S, Ferreros I, Pérez-Vicente R, Librero J, Catalá-López F, et al. Adherence to evidence-based therapies after acute coronary syndrome: a retrospective population-based cohort study linking hospital, outpatient, and pharmacy health information systems in Valencia, Spain. J Manag Care Pharm 2013;19(3):247–57.

Kumbhani DJ, Fonarow GC, Cannon CP, Hernandez AF, Peterson ED, Peacock WF, et al. Predictors of adherence to performance measures in patients with acute myocardial infarction. Am J Med 2013;126(1):74.e1–9.

Kassab YW, Hassan Y, Aziz NA, Zulkifly HH, Iqbal MS. Report: Trends in adherence to secondary prevention medications in post-acute coronary syndrome patients. Pak J Pharm Sci 2015;28(2):641–6.

Kronish IM, Ye S. Adherence to cardiovascular medications: lessons learned and future directions. Prog Cardiovasc Dis 2013;55(6):590–600.

Zullig LL, Shaw RJ, Shah BR, Peterson ED, Lindquist JH, Crowley MJ, et al. Patient–provider communication, self-reported medication adherence, and race in a postmyocardial infarction population. Patient Prefer Adherence 2015;9:311–8.

Tantikosoom P, Aungsuroch Y, Jitpanya C. Factors predicting medication adherence among cardiovascular patients in a primary care setting. Pacific Rim Int J Nurs Res 2011;15(4):278–87.

Swieczkowski D, Mogielnicki M, Cwalina N, Zuk G, Pisowodzka I, Ciecwierz D, et al. Medication adherence in patients after percutaneous coronary intervention due to acute myocardial infarction: From research to clinical implications. Cardiol J 2016;23(5):483–90.

Cheng K, Ingram N, Keenan J, Choudhury RP. Evidence of poor adherence to secondary prevention after acute coronary syndromes: possible remedies through the application of new technologies. Open Heart 2015;2(1):e000166.

Castellano JM, Sanz G, Peñalvo JL, Bansilal S, Fernández-Ortiz A, Alvarez L, et al. A polypill strategy to improve adherence: results from the FOCUS project. J Am Coll Cardiol 2014;64(20):2071–82.

Gehi AK, Ali S, Na B, Whooley MA. Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the heart and soul study. Arch Intern Med 2007;167(16):1798–803.

Published

2018-11-26

Issue

Vol. 30 No. 4 (2018): JOURNAL OF AYUB MEDICAL COLLEGE, ABBOTTABAD

Section

ORIGINAL ARTICLE

License

Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License  CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.

USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.

AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.