title: Association between patient beliefs and medication adherence following hospitalization for acute coronary syndrome.
abstract: BACKGROUND
  Patient adherence to medications is crucial for reducing risks following acute coronary syndrome (ACS). We assessed the degree to which medication beliefs were associated with patient adherence to β-blockers, angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB), and lipid-lowering medications (LL) 3 months following ACS hospitalization.
  
  
  METHODS
  We enrolled eligible ACS patients from 41 hospitals to participate in a telephone survey. The Beliefs in Medication Questionnaire-Specific was administered to assess perceived necessity for and concerns about heart medications. Three cohorts were identified for analysis: β-blockers, ACEI/ARBs, and LL. Patients discharged on or starting the medication class after discharge were included in the cohort. The primary outcome was self-reported nonadherence to the medication class 3 months following hospitalization. Factors associated with nonadherence to each medication class were determined using logistic regression analysis.
  
  
  RESULTS
  Overall, 973 patients were surveyed. Of these, 882 were in the β-blocker cohort, 702 in the ACEI/ARB cohort, and 873 in the LL cohort. Nonadherence rates at 3 months were 23%, 26%, and 23%, respectively. In adjusted analyses, greater perceived necessity for heart medications was significantly associated with lower likelihood of nonadherence in all cohorts (β-blocker: odds ratio 0.94, 95% CI 0.91-0.98; ACEI/ARB: OR 0.94, 95% CI 0.90-0.98; LL: OR 0.96, 95% CI 0.92-1.00). A greater perceived concern was significantly associated with a higher likelihood of nonadherence in all cohorts (β-blocker: OR 1.08, 95% CI 1.04-1.13; ACEI/ARB: OR 1.07, 95% CI 1.02-1.11; LL: OR 1.09, 95% CI 1.05-1.14).
  
  
  CONCLUSIONS
  Patients' perceived necessity for and concerns about heart medication were independently associated with adherence to 3 medication classes. Assessment of patient beliefs may be useful in clinical practice to identify those at greatest risk for nonadherence and to stimulate development of individualized interventions to change beliefs and improve adherence.
authors.affiliation: Division of Clinical Pharmacology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA. allen003@mc.duke.edu
authors.forename: Nancy M
authors.initials: NM
authors.lastname: Allen LaPointe
authors.forename: Fang-Shu
authors.initials: FS
authors.lastname: Ou
authors.forename: Sara B
authors.initials: SB
authors.lastname: Calvert
authors.forename: Chiara
authors.initials: C
authors.lastname: Melloni
authors.forename: Judith A
authors.initials: JA
authors.lastname: Stafford
authors.forename: Tina
authors.initials: T
authors.lastname: Harding
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Karen P
authors.initials: KP
authors.lastname: Alexander
mesh_terms: D054058:Acute Coronary Syndrome / Q000523:psychology / Q000628:therapy*; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003469:Culture; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D055118:Medication Adherence; D010349:Patient Compliance; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use
chemical_list: D000319:Adrenergic beta-Antagonists; D047228:Angiotensin II Type 1 Receptor Blockers; D000806:Angiotensin-Converting Enzyme Inhibitors; D010975:Platelet Aggregation Inhibitors