Abstract 17358: The Determinants of Nonadherence to Long-term Medical Therapy in Post Myocardial Infarction
Background: Nonadherence to long-term therapies increases future events and health care costs in patients with myocardial infarction (MI). The aim of study was to search for the major determinants of nonadherence to long-term therapies in MI.
Methods: We enrolled the 517 patients taking medicines > 1 year after the attack of MI. Adherence was measured by a self-reported questionnaire, and nonadherence was classified to be intentional (e.g., deliberately choosing not to take medicines or to change medication dosage, three items) or unintentional (e.g., forgetting to take medication, four items). The devices to assess the determining factors of adherence included Belief about Medication Questionnaire, ENRICHD Enhancing Recovery in Coronary Heart Disease Social Support Instrument, Lubben Social Network Scale- 6, Hospital Anxiety and Depression Scale. We also conducted a survey to assess healthy adherence effects.
Results: About three quarters of patients were non-adherent (n= 377, 72.9%). Among them, 364 (70.4%) patients were unintentionally and 112 (21.7%) patients were intentionally nonadherent. Moreover, 99 (19.1%) patients showed both unintentional and intentional nonadherence. The determinants of unintentional nonadherence were age [Exp(B)=1.034, p=0.013], Necessity [Exp(B)=1.106, p=0.005], Concerns [Exp(B)=0.809, p<0.001] and anxiety [Exp(B)=1.081, p=0.044]. Necessity [Exp(B)=1.199, p<0.001], Concerns [Exp(B)=0.757, p<0.001] and social network [Exp(B)=1.048, p=0.034] affected the unintentional nonadherence. Adherent patients well followed low-salt diet [Exp(B)=1.858, p=0.002], exercised regularly [Exp(B)=1.618, p=0.013] and managed well with their stress [Exp(B)=1.485, p=0.049].
Conclusion: Nonadherence was frequent in long-term management after MI. Necessity and concerns to medicines were important determinants of both intentional and unintentional nonadherence. Elderly and anxious patients were prone to unintentional nonadherence and building social networks was important for the intentionally nonadherent patients.
- © 2013 by American Heart Association, Inc.