Journal of General Internal Medicine

, Volume 30, Issue 1, pp 83–90 | Cite as

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

  • Matthew J. CrowleyEmail author
  • Leah L. Zullig
  • Bimal R. Shah
  • Ryan J. Shaw
  • Jennifer H. Lindquist
  • Eric D. Peterson
  • Hayden B. Bosworth
Original Research



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.


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.


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


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.


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


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.


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.


cardiovascular disease medication non-adherence psychosocial health beliefs 



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.


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Copyright information

© Society of General Internal Medicine 2014

Authors and Affiliations

  • Matthew J. Crowley
    • 1
    • 2
    • 3
    Email author
  • Leah L. Zullig
    • 1
    • 2
  • Bimal R. Shah
    • 2
    • 3
  • Ryan J. Shaw
    • 1
    • 4
  • Jennifer H. Lindquist
    • 1
  • Eric D. Peterson
    • 2
    • 3
  • Hayden B. Bosworth
    • 1
    • 2
  1. 1.Center for Health Services Research in Primary CareDurham VA Medical CenterDurhamUSA
  2. 2.Department of MedicineDuke UniversityDurhamUSA
  3. 3.Duke Clinical Research InstituteDurhamUSA
  4. 4.Duke University School of NursingDurhamUSA

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