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CARDIOLOGY

Adherence to Medications by Patients After Acute Coronary Syndromes

Medical Student, College of Medicine, University of Michigan, Ann Arbor, MI

Eva M Kline-Rogers, MS RN

Cardiology Research Nurse, Division of Cardiology, University of Michigan Health System

Kim A Eagle, MD

Professor, Division of Cardiology, University of Michigan Health System

Jianming Fang, PhD

Statistician, Division of Cardiology, University of Michigan Health System

David F Armstrong, MD

General Internal Medicine Resident, Division of Cardiology, University of Michigan Health System

Krishna Rangarajan, MD

Undergraduate Research Student, Division of Cardiology, University of Michigan Health System

Richard F Otten, MD

General Internal Medicine Resident, Division of Cardiology, University of Michigan Health System

Dana R Stafkey-Mailey, PharmD

PhD Candidate, at time of the study, Pharmacoeconomics Fellow, Division of Cardiology, University of Michigan Health System and Pfizer, Inc.; now, Pharmaceutical Economics and Policy, School of Pharmacy, University of Southern California, Los Angeles, CA

Stephanie D Taylor, PhD

Assistant Professor, College of Pharmacy, University of Michigan

Steven R Erickson, PharmD

Associate Professor, College of Pharmacy, University of Michigan

Reprints: Dr. Erickson, College of Pharmacy, University of Michigan, 428 Church St., Ann Arbor, MI 48109-1065, fax 734/763-2022, serick{at}umich.edu

BACKGROUND: Nonadherence to medication may lead to poor medical outcomes.

OBJECTIVE: To describe medication-taking behavior of patients with a history of acute coronary syndromes (ACS) for 4 classes of drugs and determine the relationship between self-reported adherence and patient characteristics.

METHODS: Consenting patients with the diagnosis of ACS were interviewed by telephone approximately 10 months after discharge. The survey elicited data characterizing the patient, current medication regimens, beliefs about drug therapy, reasons for discontinuing medications, and adherence. The survey included the Beliefs About Medicine Questionnaire providing 4 scales: Specific Necessity, Specific Concerns, General Harm, and General Overuse, and the Medication Adherence Scale (MAS). Multivariate regression was used to determine the independent variables with the strongest association to the MAS. A p value 0.05 was considered significant for all analyses.

RESULTS: Two hundred eight patients were interviewed. Mean ± SD age was 64.9 ± 13.0 years, with 60.6% male, 95.7% white, 57.3% with a college education, 87.9% living with 1 other person, and 42% indicating excellent or very good health. The percentage of patients continuing on medication at the time of the survey category ranged from 87.4% (aspirin) to 66.0% (angiotensin-converting enzyme inhibitors). Reasons for stopping medication included physician discontinuation or adverse effects. Of patients still on drug therapy, the mean MAS was 1.3 ± 0.4, with 53.8% indicating nonadherence (score >1). The final regression model showed R² = 0.132 and included heart-related health status and Specific Necessity as significant predictor variables.

CONCLUSIONS: After ACS, not all patients continue their drugs or take them exactly as prescribed. Determining beliefs about illness and medication may be helpful in developing interventions aimed at improving adherence.

Key Words: acute coronary syndrome, adherence

Published Online, October 4, 2005. www.theannals.com, DOI 10.1345/aph.1G249

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