title: Self-reported medication adherence and cardiovascular events in patients with stable coronary heart disease: the heart and soul study.
abstract: BACKGROUND
  Nonadherence to physician treatment recommendations is an increasingly recognized cause of adverse outcomes and increased health care costs, particularly among patients with cardiovascular disease. Whether patient self-report can provide an accurate assessment of medication adherence in outpatients with stable coronary heart disease is unknown.
  
  
  METHODS
  We prospectively evaluated the risk of cardiovascular events associated with self-reported medication nonadherence in 1015 outpatients with established coronary heart disease from the Heart and Soul Study. We asked participants a single question: "In the past month, how often did you take your medications as the doctor prescribed?" Nonadherence was defined as taking medications as prescribed 75% of the time or less. Cardiovascular events (coronary heart disease death, myocardial infarction, or stroke) were identified by review of medical records during 3.9 years of follow-up. We used Cox proportional hazards analysis to determine the risk of adverse cardiovascular events associated with self-reported medication nonadherence.
  
  
  RESULTS
  Of the 1015 participants, 83 (8.2%) reported nonadherence to their medications, and 146 (14.4%) developed cardiovascular events. Nonadherent participants were more likely than adherent participants to develop cardiovascular events during 3.9 years of follow-up (22.9% vs 13.8%, P = .03). Self-reported nonadherence remained independently predictive of adverse cardiovascular events after adjusting for baseline cardiac disease severity, traditional risk factors, and depressive symptoms (hazards ratio, 2.3; 95% confidence interval, 1.3-4.3; P = .006).
  
  
  CONCLUSIONS
  In outpatients with stable coronary heart disease, self-reported medication nonadherence is associated with a greater than 2-fold increased rate of subsequent cardiovascular events. A single question about medication adherence may be a simple and effective method to identify patients at higher risk for adverse cardiovascular events.
authors.affiliation: Emory University Hospital, 1364 Clifton Rd NE, Ste 414, Atlanta, GA 30322. anilgehi@gmail.com.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Gehi
authors.forename: Sadia
authors.initials: S
authors.lastname: Ali
authors.forename: Beeya
authors.initials: B
authors.lastname: Na
authors.forename: Mary A
authors.initials: MA
authors.lastname: Whooley
mesh_terms: D000368:Aged; D003327:Coronary Disease / Q000188:drug therapy* / Q000523:psychology; D011307:Drug Prescriptions; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology; D010045:Outpatients; D010349:Patient Compliance / Q000523:psychology*; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors; D016312:Treatment Refusal / Q000523:psychology; D014481:United States / Q000453:epidemiology