Adherence to treatment assessed with the Adherence in Chronic Diseases Scale in patients after myocardial infarction (original) (raw)
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Patient Adherence to Therapy After Myocardial Infarction: A Scoping Review
Patient Preference and Adherence
Background: Patients with myocardial infarction have low adherence to secondary prevention. Patients with acute coronary syndromes usually decide not to take cardiac drugs for 7 days after discharge for various reasons and adherence rates are usually very low. The aim of this scoping review was to identify factors influencing treatment adherence after myocardial infarction and the role of interventions to improve treatment adherence. Methods: Two electronic databases (PubMed and Web of Science) were systematically searched for relevant published reviews of interventions for adherence after myocardial infarction. Inclusion criteria were study design: randomized control trial, systematic reviews; published in English; sample age ≥18 years. The methodological framework proposed by Arksey & O'Malley was used to guide the review process of the study. Results: Thirteen articles met the inclusion/exclusion criteria. Four of the thirteen studies assessed factors influencing patient adherence to therapy after myocardial infarction, the remaining studies examined various interventions increasing adherence to treatment after myocardial infarction. Conclusion: There is a need to improve adherence of patients to treatment after myocardial infarction. Studies show that the use of modern technologies and communication with the patients by phone improve adherence to treatment.
Medication Adherence In Post Myocardial Infarction Patients
Journal of Ayub Medical College, 2018
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. 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 variab...
Long-term Medication Adherence after Myocardial Infarction: Experience of a Community
The American Journal of Medicine, 2009
BACKGROUND: Adherence to evidence-based medications after myocardial infarction is associated with improved outcomes. However, long-term data on factors affecting medication adherence after myocardial infarction are lacking. METHODS: Olmsted County residents hospitalized with myocardial infarction from 1997-2006 were identified. Adherence to HMG-CoA reductase inhibitors (statins), beta blockers, angiotensin-converting enzyme inhibitors, and angiotensin II receptor blockers, were examined. Cox proportional hazard regression was used to determine the factors associated with medication adherence over time. RESULTS: Among 292 subjects with incident myocardial infarction (63% men, mean age 65 years), patients were followed for an average of 52 Ϯ 31 months. Adherence to guideline-recommended medications decreased over time, with 3-year medication continuation rates of 44%, 48%, and 43% for statins, beta-blockers, and angiotensin-converting enzyme inhibitors/angiotensin II receptor blockers, respectively. Enrollment in a cardiac rehabilitation program was associated with an improved likelihood of continuing medications, with adjusted hazard ratio (95% confidence interval) for discontinuation of statins and beta-blockers among cardiac rehabilitation participants of 0.66 (0.45-0.92) and 0.70 (0.49-0.98), respectively. Smoking at the time of myocardial infarction was associated with a decreased likelihood of continuing medications, although results did not reach statistical significance. There were no observed associations between demographic characteristics, clinical characteristics of the myocardial infarction, and medication adherence. CONCLUSIONS: After myocardial infarction, a large proportion of patients discontinue use of medications over time. Enrollment in cardiac rehabilitation after myocardial infarction is associated with improved medication adherence.
Medication adherence after myocardial infarction: A single center retrospective cohort study
Turkish Journal of Clinics and Laboratory, 2019
Aim: The study is designed to compare the discharge prescriptions of ST-elevated (STEMI) and non ST-elevated (NSTEMI) myocardial infarction patients and the medications used end of first year and also to investigate the relationship between MI type, gender, age groups and drug adherence.Material and Methods: In retrospect, data from 413 patients were collected via epicrisis and phone visits. Discharge and the outpatient medications end of one year were compared.Results: Of the 413 patients included in the study, 312 (%75) were male. MI type distribution was NSTEMI with a ratio of 38.5% (n = 159) and STEMI with a ratio of 61.5% (n = 254). Only 2 (0.5%) patients did not receive acetylsalicylic acid (ASA) at discharge. The rate of beta-blocker, statin, clopidogrel users were %94.4, %97.1 and %97.8, respectively. The rate of patients who used five drugs (ASA, beta blocker, ACEI/ARB, statin, clopidogrel) at discharge was 78.7% (n = 325). At the end of first year, the rate of ASA, statin,...
Medication adherence among persons with post-acute myocardial infarction
2016
This study was to test a model explaining the influence of financial status, education, social support, symptom severity, barriers, knowledge, depression, and self-efficacy on medication adherence among persons with post-acute myocardial infarction. The use of multi-stage cluster sampling method involved 348 patients from 9 regional hospitals in Thailand. The results revealed the hypothesized model fit to the empirical data and explained 20% of the variance of medication adherence ( = 5.87, df = 5, p < .43, Chi-square/df = 0.97, GIF = 0.99, RMSEA = 0.065, AGFI = 0.97). Depression was the most influential factor affecting medication adherence, and had a negative direct effect (-.40, p < .05), followed by self-efficacy and barriers (.17 and .10, p < .05, respectively). These findings suggest that nurses should understand that depression, barrier, and selfefficacy are important factors to be considerate to improve medication adherence and improve the quality of life of Thai p...
Medications Adherence for Patients with Myocardial Infarction
Zagazig Nursing Journal
Background: Adherence to prescribed medication is crucial part for patients with myocardial infarction and prevent catastrophic complications unfortunately death. Aim of the study: Was to assess medications adherence level for patients with myocardial infarction. Subjects and Methods: Research design: A descriptive design was adopted to carry out this study. Setting: The study was conducted at cardiac outpatient clinics at Zagazig University hospitals, Egypt. Subjects: A purposive sample of (100) patients with MI was conducted. Tools of data collection: Two tools were used, tool I: An Interview questionnaire about demographic characteristics and medical history of studied patients Tool II: adherence to refill and medication scale. Results: The current study revealed that (65%) were males with the mean age was 58.75±10.4, (70%) were educated, (87%) had scarce income, (52%) were smokers, the mean of disease duration per years was 4.2±3.5, (48%) had hypertension while (65%) were diabetic, (50%) organized follow up visit to outpatient's clinic each three months or earlier, finally, (82%) of the studied patients were adherent to cardiovascular medications with mean± SD (21.66±5.4). Conclusion: Studied patients with MI were adherent to cardiovascular medications. And gender, education, duration of the disease had relation to medication adherence. Recommendations Further studies to assess adherence of patients with myocardial infarction patients to therapeutic regimen not medications only and factors affecting on adherence.
Untangling the relationship between medication adherence and post–myocardial infarction outcomes
American Heart Journal, 2014
Background Patients who adhere to medications experience better outcomes than their nonadherent counterparts. However, these observations may be confounded by patient behaviors. The level of adherence necessary for patients to derive benefit and whether adherence to all agents is important for diseases that require multiple drugs remain unclear. This study quantifies the relationship between medication adherence and post-myocardial infarction (MI) adverse coronary events. Methods This is a secondary analysis of the randomized MI FREEE trial. Patients who received full prescription coverage were classified as adherent (proportion of days covered ≥80%) or not based upon achieved adherence in the 6 months after randomization. First major vascular event or revascularization rates were compared using multivariable Cox models adjusting for comorbidity and health-seeking behavior. Results Compared with patients randomized to usual care, full coverage patients adherent to statin, β-blocker, or angiotensin-converting enzyme inhibitor/angiotensin receptor blocker were significantly less likely to experience the study's primary outcome (hazard ratio [HR] range 0.64-0.81). In contrast, nonadherent patients derived no benefit (HR range 0.98-1.04, P ≤ .01 for the difference in HRs between adherent and nonadherent patients). Partially adherent patients had no reduction in clinical outcomes for any of the drugs evaluated, although their achieved adherence was higher than that among controls. Conclusion Achieving high levels of adherence to each and all guideline-recommended post-MI secondary prevention medication is associated with improved event-free survival. Lower levels of adherence appear less protective.
Pharmacoepidemiology and Drug Safety, 2008
BackgroundPoor levels of medication adherence for patients with coronary heart disease (CHD) have been documented but it is unclear whether adherence has improved over time.Poor levels of medication adherence for patients with coronary heart disease (CHD) have been documented but it is unclear whether adherence has improved over time.MethodsWe assembled a retrospective cohort of lower-income Medicare beneficiaries who were discharged from the hospital after their first acute myocardial infarction (MI) between 1 January 1995 and 31 December 2003. For patients prescribed a statin, ACEI/ARB, beta-blocker, and all 3 of these medications after the hospital discharge, we evaluated medication adherence by determining the proportion of days covered (PDC) for each medication in the subsequent year.We assembled a retrospective cohort of lower-income Medicare beneficiaries who were discharged from the hospital after their first acute myocardial infarction (MI) between 1 January 1995 and 31 December 2003. For patients prescribed a statin, ACEI/ARB, beta-blocker, and all 3 of these medications after the hospital discharge, we evaluated medication adherence by determining the proportion of days covered (PDC) for each medication in the subsequent year.ResultsOur cohort consisted of a total of 33 646 patients. Adherence rates for statins and beta-blockers, but not ACEI/ARB, increased significantly over time but remained suboptimal. For example, among those patients that received a statin after discharge, 38.6% were fully adherent with therapy in 1995 in contrast to 56.2% in 2003 (p value for trend <0.001). Of patients prescribed all 3 of statin, beta-blocker, and ACEI/ARB, 29.1% and 46.4% were fully adherent in 1995 and 2003, respectively (p value for trend <0.001).Our cohort consisted of a total of 33 646 patients. Adherence rates for statins and beta-blockers, but not ACEI/ARB, increased significantly over time but remained suboptimal. For example, among those patients that received a statin after discharge, 38.6% were fully adherent with therapy in 1995 in contrast to 56.2% in 2003 (p value for trend <0.001). Of patients prescribed all 3 of statin, beta-blocker, and ACEI/ARB, 29.1% and 46.4% were fully adherent in 1995 and 2003, respectively (p value for trend <0.001).ConclusionsOur analysis demonstrates statistically significant but modest improvements in medication adherence for statins and beta-blockers, but not ACEI/ARBs, among patients discharged from hospital after acute MI. Despite these improvements, rates of non-adherence to these highly effective therapies remain extremely high. Given the health and economic consequences of non-adherence, the development of cost-effective strategies to improve medication adherence should be a clear priority. Copyright © 2008 John Wiley & Sons, Ltd.Our analysis demonstrates statistically significant but modest improvements in medication adherence for statins and beta-blockers, but not ACEI/ARBs, among patients discharged from hospital after acute MI. Despite these improvements, rates of non-adherence to these highly effective therapies remain extremely high. Given the health and economic consequences of non-adherence, the development of cost-effective strategies to improve medication adherence should be a clear priority. Copyright © 2008 John Wiley & Sons, Ltd.
The American Journal of Medicine, 2004
To determine the rates of patient adherence to key evidence-based therapies at 6 months after hospital discharge for an acute coronary syndrome. METHODS: In this nonrandomized, prospective, multinational, multicenter study, adherence to aspirin, beta-blockers, statins, or angiotensin-converting enzyme (ACE) inhibitors 6 months after discharge for myocardial infarction or unstable angina was assessed in 21,408 patients aged 18 years or older. Patients were enrolled at 104 tertiary and community hospitals representing a broad range of care facilities and practice settings (e.g., teaching vs. nonteaching). RESULTS: Of 13,830 patients, discontinuation of therapy was observed at 6-month follow-up in 8% of those taking aspirin on discharge, 12% of those taking beta-blockers, 20% of those taking ACE inhibitors, and 13% of those taking statins. In a multivariate analysis, adherence to beta-blocker therapy was higher in patients with a myocardial infarction (odds ratio [OR] ϭ 1.25; 95% confidence interval [CI]: 1.06 to 1.47), hypertension (OR ϭ 1.33; 95% CI: 1.15 to 1.54), ST-segment elevation myocardial infarction (OR ϭ 1.33; 95% CI: 1.11 to 1.61), or non-ST-segment elevation myocardial infarction (OR ϭ 1.25; 95% CI: 1.08 to 1.45). Aspirin adherence was higher among patients cared for by cardiologists (OR ϭ 1.45; 95% CI: 1.19 to 1.75; P Ͻ0.001) than among those cared for by nonspecialists. Male sex and prior heart failure were associated with improved adherence to ACE inhibitor therapy. Hypertension was associated with poorer adherence to statin therapy (OR ϭ 0.85; 95% CI: 0.74 to 0.99; P ϭ 0.04). CONCLUSION: Among patients prescribed key evidencebased medications at discharge, 8% to 20% were no longer taking their medication after 6 months. The reasons for noncompliance are complex, and may be elucidated by future studies of medical and social determinants.