The prevalence of medication nonadherence in post-myocardial infarction survivors and its perceived barriers and psychological correlates: a cross-sectional study in a cardiac health facility in Malaysia

Abstract

BackgroundAlthough evidence-based practice has shown the benefits of prescribed cardioprotective drugs in post-myocardial infarction (MI) survivors, adherence rates remain suboptimal. The aim of this study was to determine the prevalence and factors associated with medication nonadherence among post-MI survivors in Malaysia.Materials and methodsThis cross-sectional study was conducted from February to September 2016 among 242 post-MI survivors aged 24–96 years at the cardiology outpatient clinic in a Malaysian cardiac specialist center. The study utilized an interviewer-administered questionnaire that consisted of items adapted and modified from the validated Simplified Medication Adherence Questionnaire, sociodemographics, health factors, perceived barriers, and novel psychological attributes, which employed the modified Confusion, Hubbub, and Order Scale and the Verbal Denial in Myocardial Infarction questionnaire.ResultsThe prevalence of medication nonadherence was 74%. In the multivariable model, denial of illness (AOR 1.2, 95% CI 0.9–1.8; P=0.032), preference to traditional medicine (AOR 8.7, 95% CI 1.1–31.7; P=0.044), lack of information about illness (AOR 3.3, 95% CI 1.1–10.6; P=0.045), fear of side effects (AOR 6.4, 95% CI 2.5–16.6; P<0.001), and complex regimen (AOR 5.2, 95% CI 1.9–14.2; P=0.001) were statistically significant variables associated with medication nonadherence.ConclusionThe relatively higher medication-nonadherence rate in this study was associated with patient-, provider-, and therapy-related factors and the novel psychological attribute denial of illness. Future research should explore these factors using robust methodological techniques to determine temporality among these factors.

Medication adherence and its determinants in patients after myocardial infarction

“…These results suggest that people with previous cardiovascular events still do not sufficiently follow therapeutic recommendations. Low adherence to treatment in patients after MI may be caused by fear of therapy side effects, lack of information regarding the disease and therapy, and economic factors 14,21,23,33,34 .…”

Medication non-adherence related to patients’ attitudes and knowledge rather than socio-cultural factors: a study of cardiac clinic attendees at a public healthcare institute

“…This proportion is rather high, but similar findings have been reported in many countries including Yemen (54.2%) and Malaysia (74.0%). 10,11 Further, Mujtaba et al showed that 72.7% of patients with heart failure were non-compliant with medication, Desai et al reported that more than 50% of patients with coronary artery disease did not adhere to their prescribed therapies, and Sundbom et al reported that 66.4% of participants using prescription medication were nonadherent to their prescribed regimens. 12,13 In the current study, non-adherent patients were predominantly women, aged 51-65 years, earned a monthly household income of $3,000-5,000 (Trinidad and Tobago dollars), and were educated up to primary school level.…”

“…Ganasegeran et al reported that a preference for traditional medicine was associated with medication non-adherence in survivors of myocardial infarction. 11 Further, inadequate prescriptions (20.2%), financial issues (15.5%), medication cost, social stigma, and family support have been associated with improved medication adherence in patients with heart failure. 3,[24][25][26][27] Health system factors Few patients reported that unavailability of medication or a requirement for lifestyle changes resulted in nonadherence.…”

Factors Associated with Perceived Life Chaos among Post-Myocardial Infarction Survivors in a Malaysian Cardiac Care Facility

“…In a study conducted among HIV-infected adults in Los Angeles, Wong et al [ 3 ] found that life chaos was more prevalent among persons with risky health behaviors, homelessness, or unmet needs. Studies in the United States of America and Malaysia found an association between life chaos and adherence to treatment recommendations [ 4 , 10 , 11 ].…”