Self-Medication as a Type of Nonadherence in Cardiac Patients Over 50 Years of Age

Self-medication is widely discussed regarding over-the-counter pharmaceutical drugs, as well as some prescription drugs, especially antibiotics. There are virtually no studies on selfmedication with cardiovascular drugs.

To assess the prevalence of self-medication and adherence to prescribed treatment in patients with Cardiovascular Diseases (CVD) seeking advice at a cardiology dispensary.

Our cross-sectional study included all patients aged 50 years or older (n=300) who repeatedly visited an outpatient clinic for CVD from December 14, 2023, to August 07, 2024. The information on previously prescribed and actually taken medicinal drugs by the patient was recorded during the visit. Patient-reported adherence was evaluated using a specific scale.

Self-medication was detected in 120 patients (40%) who either replaced or added drugs to the therapy prescribed by their attending physician. The most common recorded practice was self-prescription of medicinal drugs (106 cases, 88.3%), especially prescription drugs (72 of 106 patients, 67.9%). In 17 patients, self-medication led to inappropriate administration of the drug. In 7 patients (41.2%), self-medication resulted in potentially dangerous combinations of drugs. In 4 patients (23.5%), self-medication resulted in inadequate replacement of the drug, and in 6 patients (35.3%), duplication of drugs was noted. The majority of patients (76.3%) exhibited various violations of compliance with medical recommendations. Among patients practicing self-medication, there were more partially nonadherent patients, and in the subgroup without selfmedication, there were more completely nonadherent patients (p=0.008).

Self-medication is potentially associated with several risks, including delayed professional consultation, incorrect self-diagnosis, severe adverse reactions, dangerous drug-drug interactions, masking of severe conditions, and the risk of drug abuse. Existing literature predominantly focuses on self-medication with over-the-counter drugs. This study demonstrates that in the Russian Federation, self-medication (including the use of cardiovascular drugs) is remarkably prevalent. More than a third of the surveyed patients independently added new medications to their physician's regimen or substituted prescribed ones. Moreover, more than half of the self-medications were for prescription drugs.

Self-medication, as one of the options for nonadherence, was employed by 40% of CVD patients. In some cases, this has led to the emergence of potentially dangerous drug combinations.