Abstract
BackgroundAtrial fibrillation (AF) patients are routinely prescribed medications to prevent and treat complications, including those from common co-occurring comorbidities. However, adherence to such medications may be suboptimal. Therefore, we sought to identify risk factors for general medication non-adherence in a population of patients with atrial fibrillation.MethodsData were collected from a large, ethnically-diverse cohort of Kaiser Permanente Northern and Southern California adult members with incident diagnosed AF between January 1, 2006 and June 30, 2009. Self-reported questionnaires were completed between May 1, 2010 and September 30, 2010, assessing patient socio-demographics, health behaviors, health status, medical history and medication adherence. Medication adherence was assessed using a previously validated 3-item questionnaire. Medication non-adherence was defined as either taking medication(s) as the doctor prescribed 75% of the time or less, or forgetting or choosing to skip one or more medication(s) once per week or more. Electronic health records were used to obtain additional data on medical history. Multivariable logistic regression analyses examined the associations between patient characteristics and self-reported general medication adherence among patients with complete questionnaire data.ResultsAmong 12,159 patients with complete questionnaire data, 6.3% (n = 771) reported medication non-adherence. Minority race/ethnicity versus non-Hispanic white, not married/with partner versus married/with partner, physical inactivity versus physically active, alcohol use versus no alcohol use, any days of self-reported poor physical health, mental health and/or sleep quality in the past 30 days versus 0 days, memory decline versus no memory decline, inadequate versus adequate health literacy, low-dose aspirin use versus no low-dose aspirin use, and diabetes mellitus were associated with higher adjusted odds of non-adherence, whereas, ages 65–84 years versus < 65 years of age, a Charlson Comorbidity Index score ≥ 3 versus 0, and hypertension were associated with lower adjusted odds of non-adherence.ConclusionsSeveral potentially preventable and/or modifiable risk factors related to medication non-adherence and a few non-modifiable risk factors were identified. These risk factors should be considered when assessing medication adherence among patients diagnosed with AF.
Highlights
Atrial fibrillation (AF) patients are routinely prescribed medications to prevent and treat complications, including those from common co-occurring comorbidities
Dementia, mental function and the complexity of the dosing regimen have been found to decrease medication adherence in patients with AF [20, 22, 28]. Identifying those AF patients at greatest risk for general medication non-adherence remains a difficult task. To address this knowledge gap, we evaluated the associations between select patient characteristics and self-reported medication adherence within a large, ethnically diverse population of adults with incident diagnosed AF to elucidate those patients who may be at greatest risk for medication non-adherence
Of the 12,159 patients with incident diagnosed AF who responded to the questionnaire items regarding medication adherence, 771 (6.3%) were categorized as not adherent to their prescribed medications (Table 1)
Summary
Atrial fibrillation (AF) patients are routinely prescribed medications to prevent and treat complications, including those from common co-occurring comorbidities. Adherence to such medications may be suboptimal. For individuals with AF, the most frequent cardiovascular complications include ischemic stroke, heart failure and sudden cardiac death [4]. To prevent such complications, medications, including anticoagulants, are prescribed to lower the risk of ischemic stroke and other arterial thromboembolisms [5]. Adherence to such prescribed medications is suboptimal and can translate into an increased risk of treatment failure, hospitalizations and early mortality [9,10,11,12,13,14,15]
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