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Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors

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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.

DESIGN

We performed secondary analysis of baseline data from a randomized trial.

PATIENTS

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.

MAIN MEASURES

Baseline demographics and patient characteristics, medical comorbidities, psychosocial factors, health belief-related factors, and patient-reported medication non-adherence were analyzed.

KEY 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.

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ACKNOWLEDGMENTS

This study was supported in part by an award from the American Heart Association-Pharmaceutical Roundtable and David and Stevie Spina. Dr. Crowley is supported by a VA Health Services Research and Development Service Career Development Award (CDA 13-261), as is Dr. Zullig (CDA 13-025). Dr. Bosworth is supported by a Research Career Scientist award from the VA’s Health Services Research and Development (RCS 08-027), and has received honoraria from Takeda Pharmaceuticals, CVS/Caremark, and Sanofi Pharmaceuticals. Dr. Shah is a consultant for Castlight Health LLC, Janssen Pharmaceuticals, Cytokinetics, BMS, and Pfizer. Dr Peterson has received research grants from BMS/Sanofi, Merck/Schering, and Lilly. All other authors report no disclosures. These data have not been presented previously.

Conflict of Interest

The authors each declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Center for Health Services Research in Primary Care, Durham VA Medical Center, HSR&D (152), 508 Fulton Street, Durham, NC, 27705, USA

    Matthew J. Crowley MD, Leah L. Zullig PhD, Ryan J. Shaw PhD, RN, Jennifer H. Lindquist MStat & Hayden B. Bosworth PhD

  2. Department of Medicine, Duke University, Durham, NC, USA

    Matthew J. Crowley MD, Leah L. Zullig PhD, Bimal R. Shah MD, MBA, Eric D. Peterson MD, MPH & Hayden B. Bosworth PhD

  3. Duke Clinical Research Institute, Durham, NC, USA

    Matthew J. Crowley MD, Bimal R. Shah MD, MBA & Eric D. Peterson MD, MPH

  4. Duke University School of Nursing, Durham, NC, USA

    Ryan J. Shaw PhD, RN

Authors
  1. Matthew J. Crowley MD
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  2. Leah L. Zullig PhD
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  3. Bimal R. Shah MD, MBA
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  4. Ryan J. Shaw PhD, RN
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  5. Jennifer H. Lindquist MStat
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  6. Eric D. Peterson MD, MPH
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  7. Hayden B. Bosworth PhD
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Corresponding author

Correspondence to Matthew J. Crowley MD.

APPENDIX

APPENDIX

Table 4 Additional Information Regarding Potential Modifying Factors from the SPRITE Trial Baseline Survey
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Crowley, M.J., Zullig, L.L., Shah, B.R. et al. Medication Non-Adherence After Myocardial Infarction: An Exploration of Modifying Factors. J GEN INTERN MED 30, 83–90 (2015). https://doi.org/10.1007/s11606-014-3072-x

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  • DOI: https://doi.org/10.1007/s11606-014-3072-x

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