Medication non-adherence is common and a primary reason for poor medical outcomes among individuals with heart failure (HF). This study’s aims were to determine whether depression, hostility, and the personality-based Millon Behavioral Medicine Diagnostic (MBMD) Medication Abuse scale were associated with medication adherence (e.g., beta-blockers, ACE inhibitors, diuretics, statins) beyond contributions of demographic, medical, and psychosocial variables in an ethnically-diverse sample of 105 men and women diagnosed with HF. In hierarchical regression, greater MBMD Medication Abuse scale scores were associated with poorer adherence above and beyond both depression (β = .236, t = 2.113, p = .037) and hostility (β = .244, t = 2.506, p = .014). The Medication Abuse scale also completely mediated the relationship between adherence and depression. These findings suggest that personality measures such as the MBMD and hostility scales might be utilized in future studies investigating predictors of adherence and also used clinically to predict medication adherence among HF patients.
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New York Heart Association class is a subjective rating assigned by a patient’s cardiologist of overall level of functioning based on a patient self-report of daily activity and symptom severity. Class ratings range from I to IV, with a higher rating representing worsening functioning.
American Heart Association (2002) Heart Disease and Stroke Statistics-2002 Update. Dallas, TX.
American Heart Association (2005) Heart Disease and Stroke Statistics-2005 Update. Dallas, TX.
Bane, C., Hughes, C. M., & McElnay, J. C. (2006). The impact of depressive symptoms and psychosocial factors on medication adherence in cardiovascular disease. Patient Education and Counseling, 60, 187–193.
Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.
Chapman, R. H., Benner, J. S., Petrilla, A. A., Tierce, J. C., Collins, S. R., Battleman, D. S., et al. (2005). Predictors of adherence with antihypertensive and lipid-lowering therapy. Archives of Internal Medicine, 165, 1147–1152.
Cook, W. W., & Medley, D. M. (1954). Proposed hostility and pharisaic-virtue scales for the MMPI. Journal of Applied Psychology, 38, 414–418.
Cramer, J. A., Mattson, R. H., Prevey, M. L., Scheyer, R. D., & Oulette, V. L. (1989). How often is medication taken as prescribed? A novel assessment technique. JAMA, 261, 3273–3277.
Cruess, D. G., Localio, R., Platt, A. B., Brensinger, C. M., Christie, J. D., Gross, R., et al. (2010). Patient attitudinal and behavioral factors associated with warfarin non-adherence at outpatient anticoagulation clinics. International Journal of Behavioral Medicine, 17, 33–42.
Cruess, D. G., Minor, S., Antoni, M. H., & Millon, T. (2007). Utility of the Millon Behavioral Medicine Diagnostic (MBMD) to predict adherence to highly active antiretroviral therapy (HAART) medication regimens among HIV-positive men and women. Journal of Personality Assessment, 89, 277–290.
De Geest, S., Scheurweghs, L., Reynders, I., Pelemans, W., Droogné, W., Van Cleemput, J., et al. (2003). Differences in psychosocial and behavioral profiles between heart failure patients admitted to cardiology and geriatric wards. European Journal of Heart Failure, 5, 557–567.
Eagle, K. A., Kline-Rogers, E., Goodman, S. G., Gurfinkel, E. P., Avezum, A., Flather, M., et al. (2004). Adherence to evidence-based therapies after discharge for acute coronary syndromes: An ongoing prospective, observational study. American Journal of Medicine, 117, 73–81.
Erickson, S. R., Coombs, J. H., Kirking, D. M., & Azimi, A. R. (2001). Compliance from self-reported versus pharmacy claims data with metered-dose inhalers. Annals of Pharmacotherapy, 35, 997–1003.
Evangelista, L. S., Berg, J., & Dracup, K. (2001). Relationship between psychosocial variables and compliance in patients with heart failure. Heart and Lung, 30, 294–301.
George, J., & Shalansky, S. J. (2006). Predictors of refill non-adherence in patients with heart failure. British Journal of Clinical Pharmacology, 63, 488–493.
Granger, B. B., Swedberg, K., Ekman, I., Granger, C. B., Olofsson, B., McMurray, J. J., et al. (2005). Adherence to candesartan and placebo and outcomes in chronic heart failure in the CHARM programme: Double-blind, randomized, controlled clinical trial. Lancet, 366, 2005–2011.
Greenglass, E. R., & Julkunen, J. (1991). Cook-Medley hostility, anger, and the Type A behavior pattern in Finland. Psychological Reports, 68(3), 1059–1066.
Gwadry-Sridhar, F. H., Arnold, J. M., Zhang, Y., Brown, J. E., Marchiori, G., & Guyatt, G. (2005). Pilot study to determine the impact of a multidisciplinary educational intervention in patients hospitalized with heart failure. American Heart Journal, 150, 982.
Hauptman, P. J. (2008). Medication adherence in heart failure. Heart Failure Reviews, 13, 99–106.
Holtgraves, T. (2004). Social desirability and self-reports: Testing models of socially desirable responding. Personality and Social Psychology Bulletin, 30, 161–172.
Horne, R., & Weinman, J. (1999). Patients’ beliefs about prescribed medicines and their role in adherence to treatment in chronic physical illness. Journal of Psychosomatic Research, 47, 555–567.
Horwitz, R. I., Viscoli, C. M., Berkman, L., Donaldson, R. M., Horwitz, S. M., Murray, C. J., et al. (1990). Treatment adherence and risk of death after a myocardial infarction. Lancet, 336, 542–545.
Hunt, S. A., Baker, D. W., Chin, M. H., Cinquegrani, M. P., Feldman, A. M., Francis, G. S., et al. (2002). ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: Executive summary. Journal of Heart and Lung Transplant, 21, 189–203.
Hunt, H. A., Abraham, W. T., Chin, M. H., Feldman, A. M., Francis, G. S., Ganiats, T. G., et al. American College of Cardiology; American Heart Association Task Force on Practice Guidelines; American College of Chest Physicians; International Society for Heart and Lung Transplantation; Heart Rhythm Society. (2005). Update for the diagnosis and management of chronic heart failure in the adult: Summary article. Circulation, 112, 1825–1852.
Kawachi, I., Sparrow, D., Spiro, A. I., Vokonas, P., & Weiss, S. T. (1995). A prospective study of anger and coronary heart disease: The Normative Aging Study. Circulation, 84, 2090–2095.
Khanderia, U., Townsend, K. A., Erickson, S. R., Vlasnik, J., Prager, R. L., & Eagle, K. A. (2008). Medication adherence following coronary artery bypass graft surgery: Assessment of beliefs and attitudes. Annals of Pharmacotherapy, 42, 192–199.
Kramer, J. M., Hammill, B., Anstrom, K. J., Fetterolf, D., Snyder, R., Charde, J. P., et al. (2006). National evaluation of adherence to beta-blocker therapy for 1 year after acute myocardial infarction in patients with commercial health insurance. American Heart Journal, 152, 1–8.
Krumholz, H. M., Amatruda, J., Smith, G. L., Mattera, J. A., Roumanis, S. A., Radford, M. J., et al. (2002). Randomized trial of an education and support intervention to prevent readmission of patients with heart failure. Journal of American College of Cardiology, 39, 83–89.
Krumholz, H. M., Parent, E. M., Tu, N., Vaccarino, V., Wang, Y., Radford, M. J., et al. (1997). Readmission after hospitalization for congestive heart failure among medicare beneficiaries. Archives of Internal Medicine, 157, 99–104.
Lamb, D. A., Eurich, D. T., McAlister, F. A., Tsuyuki, R. T., Semchuk, W. M., Wilson, T. W., et al. (2009). Changes in adherence to evidence-based medications in the first year after initial hospitalization for heart failure: Observational cohort study from 1994 to 2003. Circulation: Cardiovascular Quality and Outcomes, 2, 229–235.
Maguire, L. K., Hughes, C. M., & McElnay, J. C. (2008). Exploring the impact of depressive symptoms and medication beliefs on medication adherence in hypertension—a primary care study. Patient Education and Counseling, 73, 371–376.
McAlister, F. A., Man-Son-Hing, M., Straus, S. E., Ghali, W. A., Gibson, P., Anderson, D., et al. (2004). A randomized trial to assess the impact of an antrithrombotic decision aid in patients with nonvalvular atrial fibrillation: The DAAFI trial protocol (ISRCTNI4429643). BMC Cardiovascular Disorders, 4, 5.
McDonald, H. P., Garg, A. X., & Haynes, R. B. (2002). Interventions to enhance patient adherence to medication prescriptions. JAMA, 288, 2868–2879.
Michalsen, A., Konig, G., & Thimme, W. (1998). Preventable causative factors leading to hospital admission with decompensated heart failure. Heart, 80(5), 437–441.
Miller, T. Q., Smith, T. W., Turner, C. W., Guijarro, M. L., & Hallet, A. J. (1996). A meta-analytic review of research on hostility and physical health. Psychological Bulletin, 119, 322–348.
Millon, T., Antoni, M., Millon, C., Meagher, S., & Grossman, S. (2001). Millon Behavioral Medicine Diagnostic. Minneapolis, MN: NCS Assessments.
Miura, T., Kojima, R., Mizutani, M., Shiga, Y., Takatsu, F., & Suzuki, Y. (2001). Effect of digoxin noncompliance on hospitalization and mortality in patients with heart failure in long-term therapy: A prospective cohort study. European Journal of Clinical Pharmacology, 57, 77–83.
Morgan, A. L., Masoudi, F. A., Havranek, E. P., Jones, P. G., Peterson, P. N., Drumholz, H. M., et al.; for the Cardiovascular outcomes research consortium. (2006). Difficulty taking medications, depression, and health status in heart failure patients. Journal of Cardiac Failure, 12, 54–60.
Morisky, D. E., Green, L. W., & Levine, D. M. (1986). Concurrent and predictive validity of a self-reported measure of medication adherence. Medical Care, 24, 67–74.
Ni, H., Nauman, D., Burgess, D., Wise, K., Crispell, K., & Hershberger, R. E. (1999). Factors influencing knowledge of and adherence to self-care among patients with heart failure. Archives of Internal Medicine, 159, 1613–1619.
Opasich, C., Rapezzi, C., Lucci, D., Gorini, M., Pozzar, F., Zanelli, E., et al.; Italian Network on Congestive Heart Failure (IN-CHF) Investigators. (2001). Precipitating factors and decision-making processes of short-term worsening in heart failure despite “optimal” treatment (from the IN-CHF Registry). American Journal of Cardiology, 88, 382–387.
Pamboukian, S. V., Nisar, I., Patel, S., Gu, L., McLeod, M., Costanzo, M. R., et al. (2008). Factors associated with non-adherence to therapy with warfarin in a population of chronic heart failure patients. Clinical Cardiology, 31, 30–34.
Park, D. C., Willis, S. L., Morrow, D., Diehl, M., & Gaines, C. L. (1994). Cognitive function and medication usage in older adults. Journal of Applied Gerontology, 13, 39–57.
Pearson, C. R., Simoni, J. M., Hoff, P., Kurth, A. E., & Martin, D. P. (2007). Assessing antiretroviral adherence via electronic drug monitoring and self-report: An examination of key methodological issues. AIDS and Behavior, 11, 161–173.
Phatak, H. M., & Thomas, J., I. I. I. (2006). Relationships between beliefs about medications and nonadherence to prescribed chronic medications. American Pharmacotherapy, 40, 1737–1742.
Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401.
Rasmussen, J. N., Chong, A., & Alter, D. A. (2007). Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA, 297, 177–186.
Rich, M. W., Gray, D. B., Beckham, V., Wittenberg, C., & Luther, P. (1996). Effect of a multidisciplinary intervention on medication compliance in elderly patients with congestive heart failure. American Journal of Medicine, 101, 270–276.
Rich, M. W., Vinson, J. M., Sperry, J. C., Shah, A. S., Spinner, L. R., Chung, M. K., et al. (1993). Prevention of readmission in elderly patients with congestive heart failure: Results of a prospective, randomized pilot study. Journal of General Internal Medicine, 8, 585–590.
Schwarz, K. A., & Elman, C. S. (2003). Identification of factors predictive of hospital readmissions for patients with heart failure. Heart and Lung, 32, 88–99.
Shalansky, S. J., & Levy, A. R. (2002). Effect of the number of medications on cardiovascular therapy adherence. Annals of Pharmacotherapy, 36, 1532–1539.
Sherbourne, C. D., & Stewart, A. L. (1991). The MOS Social Support Survey. Social Science Medicine, 32, 705–714.
Simpson, R. J., Jr. (2006). Challenges for improving medication adherence. JAMA, 296, 2614–2616.
Soumerai, S. B., Pierre-Jacques, M., Zhang, F., Ross-Degnan, D., Adams, A. S., Gurwitz, J., et al. (2006). Cost-related medication non-adherence among elderly and disabled medicare beneficiaries: A national survey 1 year before the medicare drug benefit. Archives of Internal Medicine, 166, 1829–1835.
Stafford, L., Jackson, H. J., & Berk, M. (2008). Illness beliefs about heart disease and adherence to secondary prevention regimens. Psychosomatic Medicine, 70, 942–948.
Stephenson, B. J., Rowe, B. H., Haynes, R. B., Macharia, W. M., & Leon, G. (1993). The rational clinical examination. Is this patient taking the treatment as prescribed? JAMA, 269, 2779–2781.
Turki, A. K., & Sulaiman, S. A. S. (2009). Adherence to antihypertensive therapy in general hospital of Penang: Does daily dose frequency matter? Jordan Journal of Pharmaceutical Sciences, 2, 167–176.
van der Wal, H. L., Jaarsma, T., Moser, D. K., Veeger, N. J. G. M., van Gilst, W. H., & van Veldhuisen, D. J. (2006). Compliance in heart failure patients: the importance of knowledge and beliefs. European Heart Journal, 27, 434–440.
Vik, S. A., Maxwell, C. J., Hogan, D. B., Patten, S. B., Johnson, J. A., & Romonko-Slack, L. (2005). Canadian Journal of Clinical Pharmacology, 12, e152–e164.
Vinson, J. M., Rich, M. W., Sperry, J. C., Shah, A. S., & McNamara, T. (1990). Early readmission of elderly patients with congestive heart failure. Journal of the American Geriatric Society, 38, 1290–1295.
Wray, J., Waters, S., Radley-Smith, R., & Sensky, T. (2006). Adherence in adolescents and young adults following heart or heart-lung transplantation. Pediatric Transplantation, 10, 694–700.
Wu, J. R., Moser, D. K., Chung, M. L., & Lennie, T. A. (2008). Objectively measured, but not self-reported, medication adherence independently predicts event-free survival in patients with heart failure. Journal of Cardiac Failure, 14, 203–210.
Wu, J. R., Moser, D. K., DeJong, M. J., Rayens, M. K., Chung, M. L., Riegel, B., et al. (2009). Defining an evidence-based cutpoint for medication adherence in heart failure. American Heart Journal, 157, 285–291.
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Farrell, K., Shen, B., Mallon, S. et al. Utility of the Millon Behavioral Medicine Diagnostic to Predict Medication Adherence in Patients Diagnosed with Heart Failure. J Clin Psychol Med Settings 18, 1–12 (2011). https://doi.org/10.1007/s10880-010-9217-0
- Heart failure