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Medication non-adherence after myocardial infarction: an exploration of modifying factors
Matthew J Crowley1, Leah L Zullig, Bimal R Shah
1Center for Health Services Research in Primary Care, Durham VA Medical Center, HSR&D (152), 508 Fulton Street, Durham, NC, 27705, USA, matthew.crowley@dm.duke.edu.
Insights
Medication non-adherence in cardiovascular disease patients is linked to younger age, higher life chaos, and stroke worry. Understanding these factors is key to improving treatment adherence and outcomes.
Area of Science:
- Cardiology
- Psychosocial Health
- Health Behavior
Background:
- Medication non-adherence significantly hinders cardiovascular disease risk factor management.
- Understanding factors influencing non-adherence in cardiovascular disease patients is crucial for developing effective interventions.
Purpose of the Study:
- To identify demographic, patient, comorbidity, psychosocial, and health belief factors associated with medication non-adherence.
- Focus on patients with established cardiovascular disease and history of myocardial infarction.
Main Methods:
- Secondary analysis of baseline data from a randomized trial.
- Included 405 patients with hypertension and recent myocardial infarction history.
- Analyzed demographics, comorbidities, psychosocial factors, health beliefs, and self-reported non-adherence.
Main Results:
- 42.7% of patients reported medication non-adherence.
- Bivariate analysis linked non-adherence to younger age, non-white race, lower education, smoking, financial insecurity, stress, life chaos, and worry about myocardial infarction or stroke.
- Multivariable analysis confirmed significant associations with younger age, higher life chaos, and greater worry about stroke.
Conclusions:
- Younger age, higher life chaos, and worry about stroke are significantly associated with medication non-adherence in cardiovascular disease patients.
- Further research should explore these factors as intervention targets.
- Investigating modifiable causes of non-adherence in this population is essential.
Background:
Medication non-adherence is a major impediment to the management of cardiovascular disease risk factors. A better understanding of the modifying factors underlying medication non-adherence among individuals with known cardiovascular disease may inform approaches for addressing non-adherence.
Objective:
The purpose of this study was to identify demographic and patient characteristics, medical comorbidities, psychosocial factors, and health belief-related factors associated with medication non-adherence among patients with known cardiovascular disease.
Design:
We performed secondary analysis of baseline data from a randomized trial.
Patients:
The study included 405 patients with a diagnosis of hypertension and history of acute myocardial infarction that was diagnosed within a three-year period prior to enrollment.
Main Measures:
Baseline demographics and patient characteristics, medical comorbidities, psychosocial factors, health belief-related factors, and patient-reported medication non-adherence were analyzed.
Key Results:
Of 405 patients, 173 (42.7 %) reported medication non-adherence. Factors associated with non-adherence in bivariate analysis included younger age, non-white race, having less than 12 years of education, smoking, financial insecurity, identifying as nervous or tense, higher life chaos score, greater worry about having a myocardial infarction, and greater worry about having a stroke. Using multivariable modeling, we determined that age (OR 0.97 per additional year, 95 % CI, 0.95-0.99), life chaos (OR 1.06 per additional point, 95 % CI, 1.00-1.11), and worry about stroke (OR 1.12 per additional point, 95 % CI, 1.01-1.25) remained significantly associated with self-reported medication non-adherence.
Conclusions:
We found that worry about having a stroke, higher life chaos, and younger age were all significantly associated with self-reported medication non-adherence in patients with cardiovascular disease and a history of myocardial infarction. Further research exploring these factors as targets for intervention is needed, as is additional research examining modifiable causes of medication non-adherence among patients with cardiovascular disease.
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