title: Medication non-adherence after myocardial infarction: an exploration of modifying factors.
abstract: BACKGROUND
  Medication non-adherence is a major impediment to the management of cardiovascular disease risk factors. A better understanding of the modifying factors underlying medication non-adherence among individuals with known cardiovascular disease may inform approaches for addressing non-adherence.
  
  
  OBJECTIVE
  The purpose of this study was to identify demographic and patient characteristics, medical comorbidities, psychosocial factors, and health belief-related factors associated with medication non-adherence among patients with known cardiovascular disease.
  
  
  METHODS
  We performed secondary analysis of baseline data from a randomized trial.
  
  
  METHODS
  The study included 405 patients with a diagnosis of hypertension and history of acute myocardial infarction that was diagnosed within a three-year period prior to enrollment.
  
  
  METHODS
  Baseline demographics and patient characteristics, medical comorbidities, psychosocial factors, health belief-related factors, and patient-reported medication non-adherence were analyzed.
  
  
  RESULTS
  Of 405 patients, 173 (42.7 %) reported medication non-adherence. Factors associated with non-adherence in bivariate analysis included younger age, non-white race, having less than 12 years of education, smoking, financial insecurity, identifying as nervous or tense, higher life chaos score, greater worry about having a myocardial infarction, and greater worry about having a stroke. Using multivariable modeling, we determined that age (OR 0.97 per additional year, 95 % CI, 0.95-0.99), life chaos (OR 1.06 per additional point, 95 % CI, 1.00-1.11), and worry about stroke (OR 1.12 per additional point, 95 % CI, 1.01-1.25) remained significantly associated with self-reported medication non-adherence.
  
  
  CONCLUSIONS
  We found that worry about having a stroke, higher life chaos, and younger age were all significantly associated with self-reported medication non-adherence in patients with cardiovascular disease and a history of myocardial infarction. Further research exploring these factors as targets for intervention is needed, as is additional research examining modifiable causes of medication non-adherence among patients with cardiovascular disease.
authors.affiliation: Center for Health Services Research in Primary Care, Durham VA Medical Center, HSR&D (152), 508 Fulton Street, Durham, NC, 27705, USA, matthew.crowley@dm.duke.edu.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Crowley
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: Bimal R
authors.initials: BR
authors.lastname: Shah
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Shaw
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Lindquist
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
mesh_terms: D000367:Age Factors; D000368:Aged; D001007:Anxiety; D001294:Attitude to Health; D002317:Cardiovascular Agents / Q000008:administration & dosage*; D015897:Comorbidity; D005260:Female; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D008019:Life Style; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy* / Q000523:psychology; D012307:Risk Factors; D012646:Self Administration / Q000523:psychology / Q000706:statistics & numerical data; D057566:Self Report; D020521:Stroke / Q000523:psychology; D016903:Drug Monitoring
chemical_list: D002317:Cardiovascular Agents