Adherence to medications by patients after acute coronary syndromes.
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 < or = 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 > or =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 R(2) = 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.
Sud
Anchal
A
College of Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
Kline-Rogers
Eva M
EM
Eagle
Kim A
KA
Fang
Jianming
J
Armstrong
David F
DF
Rangarajan
Krishna
K
Otten
Richard F
RF
Stafkey-Mailey
Dana R
DR
Taylor
Stephanie D
SD
Erickson
Steven R
SR
D000208:Acute Disease; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D003327:Coronary Disease / Q000175:diagnosis / Q000188:drug therapy*; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D015999:Multivariate Analysis; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013577:Syndrome; D013997:Time Factors; D028761:Withholding Treatment / Q000706:statistics & numerical data
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D000960:Hypolipidemic Agents; D001241:Aspirin