Background The coronary artery calcification (CAC) score determined by multi-detector row computed tomography (MDCT) predicts the onset of coronary artery disease (CAD

ObjectiveThe aim of this study was to examine the association between medication adherence and illness perceptions, and to explore the factors associated with poor medication adherence in atrial fibrillation (AF) patients receiving direct oral anticoagulants (DOACs) in a real-world clinical setting.MethodsAn observational cross-sectional pilot study was conducted at a single Japanese university hospital. One hundred and twenty-nine patients who were diagnosed with AF and who were taking DOACs were recruited from outpatients between January 4th and April 25th, 2017. We evaluated medication adherence to DOACs using the Morisky Medication Adherence Scale-8 (MMAS-8) and illness perceptions using the Brief Illness Perception Questionnaire (BIPQ). The patients’ characteristics and clinical data were collected from electronic medical records.ResultsNinety-nine (76.7%) patients (male, n = 74; mean age, 71.4±9.8 years) participated in this study. According to the MMAS-8, 21 (21.2%) of the patients were classified into the poor adherence group (MMAS-8 score of <6), and 78 (78.8%) were classified into the good adherence group (MMAS-8 score of 6–8). A multivariate logistic regression analysis revealed that age (per year, odds ratio [OR] 0.912, 95% confidence interval [CI] 0.853–0.965, p = 0.001), a history of warfarin use (OR 0.181, 95% CI 0.033–0.764, p = 0.019), duration of DOAC exposure (per 100 days, OR 1.245, 95% CI 1.084–1.460, p = 0.001), and the BIPQ emotional response score (per 1 point, OR 1.235, 95% CI 1.015–1.527, p = 0.035) were significantly associated with poor medication adherence in AF patients receiving DOACs.ConclusionPoor medication adherence to DOACs was strongly associated with a stronger emotional response (i.e. stronger feelings of anger, anxiety, and depression), as well as younger age, the absence of a history of warfarin treatment, and longer DOAC exposure. Further evaluation of the factors associated with medication adherence in AF patients and the development and execution of strategies for improving poor adherence are warranted in the real-world clinical setting.

oronary artery disease (CAD) is the most important cause of death in the industrialized world 1,2 and an efficient noninvasive method of detection is needed. Techniques for measuring coronary artery calcification (CAC) as a marker of atherosclerosis using electronbeam computed tomography (EBCT) have been developed. 3,4 Calcification as assessed by EBCT is associated with atherosclerosis at autopsy and the results of coronary angiography (CAG). 5 Multidetector row computed tomography (MDCT) has become more widely available in many general hospitals, and it is becoming increasingly likely that high-risk patients will undergo CAC scoring by MDCT as well as EBCT, because MDCT enables accurate assessment of coronary artery luminal narrowing 6,7 and several studies have shown a high correlation between CAC scores as assessed by MDCT and those determined by EBCT. 8,9 In addition, MDCT has emerged as a potential noninvasive method for imaging the coronary arteries and is a sensitive modality for the diagnosis of coronary artery stenosis. It can be very difficult to detect coronary artery stenosis if there is advanced calcification, although the CAC score has been shown to be a marker for predicting CAD. The presence of CAC can be assessed noninvasively using either EBCT or MDCT. Although several studies have revealed a correlation between CAC and angiographic stenosis, 10-16 few studies have used MDCT and it is unknown whether the CAC score is the most important predictor of significant coronary stenosis as assessed by CAG independent of other factors, such as age, body mass index and medication. To evaluate the clinical significance of the CAC score determined by MDCT, we compared coronary artery stenosis as assessed by CAG with the CAC score, coronary risk factors and medications. In addition, when it was difficult to assess the coronary artery lumen on MDCT because of severely calcified lesions, we analyzed whether a higher CAC score might be a helpful indicator of the need to perform CAG. Background The coronary artery calcification (CAC) score measured by multidetector row computed tomography (MDCT) has emerged as a marker for predicting coronary artery disease (CAD). To evaluate the clinical significance of the CAC score, coronary artery stenosis as assessed by coronary angiography (CAG) was compared with the CAC score determined by MDCT, risk factors and medications. Methods and ResultsSubjects included 374 consecutive patients who underwent ECG-gate CT angiography using MDCT. The accuracy in patients with a CAC score ≥400 was 84%, and significantly lower than that in patients with a CAC score =0. In addition 92 patients (68 males, 24 females; mean age, 63±11 years) who underwent both MDCT and CAG within a 1-month period were selected for further investigation. Patients with significant coronary stenosis had a significantly higher CAC score than those without stenosis. In addition, a higher number of stenosed vessels was associated with a higher CAC score. The subjects were divided into 3 groups according to the ...

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