Abstract
Purpose: Non-adherence to medications can be classified as unintentional and intentional. The aim of this study was to establish the major determinants of each non-adherence in myocardial infarction (MI). We also evaluated the effects of non-adherences on healthy behaviors. Materials and Methods: We enrolled 510 patients >1 year after MI. Nonadherences classified as unintentional or intentional were measured by a self-reported questionnaire. Polynomial and multiple regression analysis were performed to evaluate the determinant of each type of nonadherences. Results: Among patients with nonadherence, 263 (70.7%) patients were unintentionally non-adherent while 109 (29.3%) patients were intentionally non-adherent. Psychological belief and attitude were important in unintentional non-adherence (Exp(β) = 0.917, p = 0.050 for anxiety; Exp(β) = 1.191, p = 0.001 for concerns). Beliefs about medications were the strongest determinant of intentional non-adherence (Exp(β) = 0.812, p < 0.001 for necessity; Exp(β) = 1.421, p < 0.001 for concerns). Anxiety was important determinant of intentional non-adherence (Exp(β) = 0.889, p = 0.015). Conclusion: Psychological factors and beliefs about medication were important determinants of both types of non-adherence. Combined approaches targeting the beliefs about medications and psychological distress are needed to improve drug adherence in patients with MI.
Highlights
Non-adherence to medication is a pandemic phenomenon found in >60% of patients taking cardiovascular medications [1]
The present study showed that anxiety and depressive symptoms were associated with higher concerns regarding medications
We found that overall pill counts increased perceived necessity but had no association with perceived concerns
Summary
Non-adherence to medication is a pandemic phenomenon found in >60% of patients taking cardiovascular medications [1]. Long-term adherence further declined over time, and only one fourth of patients remained adherent over 2 years [3]. Non-adherence to optimal cardiovascular medications was associated with a 30% higher risk of cardiovascular events in MI patients [4]. Predicting or improving adherence to medications remains a challenge because multiple contributors are interwoven with each other in a complex way [5]. This suggests that strategies to improve adherence should be individualized and multifaceted [5,6]
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