Abstract
AimHealthy lifestyle behaviors and a good adherence to pharmacological treatments are important predictors of lower recurrence rates and better overall outcomes among patients with an established acute coronary syndrome (ACS). The present study sought to investigate the longitudinal trajectories of these behaviors years after the onset of an ACS.Subject and methodsWe recruited a sample of 275 newly diagnosed consecutive patients at their first ACS event (mean age: 57.1 ± 7.87 years; 84% males) admitted to a cardiac rehabilitation program from three large public hospitals in Northern Italy. Patients completed a battery of sociodemographic questionnaires, which evaluated healthy lifestyles (smoking status, alcohol intake, diet, and physical activity) and adherence to pharmacological treatments, at five time-points (pre-event, 6-, 12-, 24-, and 36-month follow-ups). Longitudinal trajectories were examined through hierarchical (generalized) linear models, controlling for several demographic and clinical variables.ResultsWe found significant changes in all healthy lifestyles from pre-event to the 6-month follow-up, suggesting the adoption of healthier behaviors soon after the cardiac event. However, from the 6-month up to the 3-year follow-up, patients experienced small but significant declines in their self-reported levels of healthy dietary behaviors and physical activity. Further, we found that the odds of being at medium risk of non-adherence to the pharmacological treatments significantly increased over the course of 3 years.ConclusionGiven the negative long-term trajectories in specific lifestyles and adherence to pharmacological treatments, cardiac rehabilitation programs are suggested to provide repeated psychological interventions aimed at fostering patients’ capabilities to self-regulate their habitual behaviors.
Highlights
In the current study we sought to investigate longitudinal trajectories and associated baseline predictors of (i) adherence to pharmacological treatments, and (ii) four unhealthy lifestyle behaviors, in a cohort of 275 consecutive acute coronary syndrome (ACS) patients at their first coronary event
We modeled the individual rate of change from pre-event over the course of 3 years follow-up through an advanced statistical technique, namely hierarchical linear models (HLMs) with a piecewise regression approach
At each time-point, anthropometric, clinical, and behavioral data were gathered: information on lifestyle before the onset of ACS was retrospectively collected during the first study visit, while that on adherence to pharmacological treatments was collected during the follow-ups
Summary
A total of 300 consecutive patients with ACS admitted to a CR program and who fulfilled the eligibility criteria were invited to participate in the study, 25 of whom refused. We found significant increases across all patients from pre-event to 6 months after (i.e., the “Time.1” slope β10), and these increases were higher among those with hypertension (β = 0.85; p = 0.005). Those who were older had reduced increases (β = −0.07; p = 0.007), compared to those who were younger. Month to the 3-year follow-up were found in this specific behavior Those with a diagnosis of dyslipidemia reported longitudinal increases over time in alcohol consumption (β = 0.07; p = 0.004).
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