Abstract 14790: Polypharmacy is a Predictor of Medication Non-adherence after Acute Coronary Syndrome: An Electronic Medication Monitoring Study
Objective: Non-adherence to prescribed medications is common in patients with cardiovascular disease. As cardiac regimens become increasingly complex, polypharmacy may play an important role in non-adherence.
Methods: Using electronic medication monitoring, we assessed aspirin adherence during a 3-month period for 172 patients recruited within 1 week of hospitalization for ACS. Baseline demographic, social, clinical and psychological data were assessed through chart abstraction and standardized questionnaires. Non-adherence was defined as aspirin taken for 5 medications.
Results: Of 172 patients, 126 of 172 (73%) patients were discharged on >5 medications, and 39 (23%) were non-adherent with aspirin. Patients discharged on >5 medications were three times more likely to be non-adherent, compared with patients discharged on ≤5 medications (27.8% vs. 8.7%; p=0.008). Non-adherent patients were more likely to have elevated depressive symptoms as defined by Beck Depression Inventory > 16 (30.8% vs. 15.0%; p=0.02), and to have had a prior MI (43.1% vs. 22.6%; p=0.01). Demographic and clinical variables that were not significantly associated with adherence included age, female gender, non-white race, partner status, education, income, UCLA loneliness score, prior CHF, GRACE score, and Charlson comorbidity index (all p>0.05). In logistic regression model adjusting for covariates with p<0.05, BDI (OR 1.05, 95% confidence interval 1.01-1.10; p=0.025 per each point increase) and polypharmacy (OR 3.53, 95% confidence interval 1.16-10.76; p=0.027) were both significant predictors for aspirin non-adherence.
Conclusions: Polypharmacy and depressive symptoms are important predictors of medication non-adherence after admission for ACS. Complexity of medical regimen as a barrier for adherence in patients with cardiovascular disease warrants further investigation.
- © 2010 by American Heart Association, Inc.