Abstract
BackgroundThe healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. Although the healthy adherer effect is supposed to affect health outcomes in patients with coronary artery disease, evaluation of its presence and extent is not easy. This study aimed to assess the relationship between medication adherence and lifestyle modifications and health-related quality of life among post-acute myocardial infarction (AMI) patients.MethodsA cross-sectional study was conducted in 417 post-AMI patients who underwent percutaneous coronary intervention (PCI). Patients were recruited from 11 university hospitals from December 2015 to March 2016 in South Korea. Details regarding socio-demographic factors, six health behaviors (low-salt intake, low-fat diet and/or weight-loss diet, regular exercise, stress reduction in daily life, drinking in moderation, and smoking cessation), medication adherence using the Modified Morisky Scale (MMS), and HRQoL using the Coronary Revascularization Outcome Questionnaire (CROQ) were surveyed in a one-on-one interview.ResultsIn the univariate logistic analysis, sex (female), age (≥70 years), MMS score (≥5), and CROQ score were associated with adherence to lifestyle modification. In the multiple logistic analysis, a high MMS score (≥5) was associated with adherence to lifestyle modification after adjusting for sex, age, marital status, education, and family income (adjusted odds ratio [OR] = 11.7, 95% confidence interval [CI] = 1.5–91.3). After further adjusting for the CROQ score, the association between high MMS score and adherence to lifestyle modification was significant (adjusted OR = 11.5, 95% CI = 1.4–93.3).ConclusionsAdherence to medication was associated with adherence to lifestyle modification, suggesting the possible presence of the healthy adherer effect in post-AMI patients. After further adjusting for HRQoL, the association remained. To improve health outcome in post-AMI patients, early detection of patients with poor adherence to medication and lifestyle modification and motivational education programs to improve adherence are important. In addition, the healthy adherer effect should be considered in clinical research, in particular, in studies evaluating the effects of therapies on health outcomes.
Highlights
The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors
We evaluated whether the relationship between medication adherence and lifestyle modification exists among postAMI patients treated with percutaneous coronary intervention (PCI)
Medication adherence to and adherence to lifestyle modification Adherence to lifestyle modification tended to be higher in females, participants of older age, and those who were married, had less education, had a low family income, and were unemployed (Table 1)
Summary
The healthy adherer effect is a phenomenon in which patients who adhere to medical therapies tend to pursue health-seeking behaviors. The phenomenon in which patients who adhere to therapies tend to pursue health-seeking behaviors is called the “healthy adherer effect”; it is a recognized problems in studies undertaken in order to evaluate the effects of medications on health outcomes [5]. This phenomenon has explained why cardiovascular outcomes from randomized clinical trials (RCTs) have had different outcomes from prior observational studies [5, 6]. In a 3-year longitudinal study of post-MI patients, adherence to guideline-recommended therapies was effective for lowering the rate of major adverse cardiovascular events (MACE) and for cost savings, even after adjusting for health-seeking behavior (flu vaccination) [9]
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