Changing illness perceptions and adherence to dual antiplatelet therapy in patients with stable coronary disease.
BACKGROUND
Platelet inhibition with dual antiplatelet therapy (DAPT) is an important component of medical management in patients with stable coronary artery disease (CAD). Dual antiplatelet therapy nonadherence is associated with increased mortality. Little is known about illness perceptions (IPs) surrounding the use of antiplatelet medications and whether they differ in stable CAD patients treated with medical and/or interventional approaches.


OBJECTIVE
The aim of this study was to examine temporal changes in IP scores for patients with stable CAD and examine the influence of clinical and demographic variables, IP, and depressive symptoms on adherence to DAPT.


METHODS
Patients (n = 180, 71.7% men; mean [SD] age, 65.1 [8.3] years) were recruited after coronary angiography and optimal medical therapy (OMT) (n = 90) or after percutaneous coronary intervention with initiation of OMT (n = 90). The Illness Perception Questionnaire-Revised and Patient Health Questionnaire-9 were administered at baseline and 30 days after treatment, with a response rate of 52.8% (n = 95) at 30 days. Adherence to DAPT (aspirin and thienopyridine) at 30 days was collected using a health history update.


RESULTS
Patients with stable CAD experienced shifts in IP within the first 30 days after treatment. Patients treated with OMT demonstrated increased symptoms after treatment (timeline cyclical) and reduced beliefs in the level of control provided by their prescribed regimen (treatment control, t = 3.26, P = .002). Both groups demonstrated an increase in perceived understanding of illness (illness coherence subscale) from baseline to 30 days (percutaneous coronary intervention/OMT, t = -4.43, P < .001; OMT, t = -3.74, P = .001). Chronic IPs were associated with 5.7% increased odds for improved adherence to thienopyridine agents (B = 0.509, P = .009, Exp(B) = 1.66) and 5.6% increased odds for aspirin use (B = 0.265, P = .031, Exp(B) = 1.30). Depressive symptoms were predictive of adherence for thienopyridine medications (B = 0.509, P = .009, Exp(B) = 1.66).


CONCLUSIONS
Illness perceptions influence adherence to DAPT in patients with stable CAD. Understanding patterns in IP after treatment may help identify the best strategies to promote a tailored approach for improving adherence to DAPT.
Michelle M. Fennessy, PhD, APRN, BC Advanced Practice Nurse, Section of Cardiology, Loyola University Medical Center, Maywood, Illinois; Doctoral Graduate, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago; and Postdoctoral Fellow, Betty Irene Moore School of Nuring, University of California, Davis, Sacramento. Holli A. DeVon, PhD, RN Associate Professor, Betty Irene Moore School of Nuring, University of California, Davis, Sacramento. Catherine Ryan, PhD, RN Research Assistant Professor, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago. John J. Lopez, MD Professor Medicine, Section of Cardiology, Codirector, Acute Myocardial Infarction Program, and Director, Interventional Cardiology Research Program, Section of Cardiology, Loyola University Medical Center, Maywood, Illinois. Julie J. Zerwic, PhD, RN Associate Professor and Executive Associate Dean, Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago.
Michelle M
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Fennessy
Holli A
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Devon
Catherine
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Ryan
John J
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Lopez
Julie J
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Zerwic
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001241:Aspirin / Q000627:therapeutic use*; D001294:Attitude to Health; D003324:Coronary Artery Disease / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D011446:Prospective Studies; D011725:Pyridines / Q000627:therapeutic use*; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D001241:Aspirin