Factors Associated With Medication Non-Adherence Among Ischemic Heart Disease Patients: Focus On Erectile Dysfunction As A Perceived Adverse Effect Of Cardioprotective Therapy
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Date
2015-10
Authors
Yousif Nori, Ali
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Ischemic Heart Disease (IHD) is the most rampant among all cardiovascular diseases
and it is the single largest cause of death in Malaysia and the world. Erectile
dysfunction (ED) is a precursor to IHD and an important vascular risk factor. It can
be organic or psychogenic and it remains under-recognised in the area of studying
adherence to long-term cardioprotective therapy prescribed for stable IHD. The
primary aim of this study was to quantify the likelihood of having ED symptoms
perceived as adverse effect of cardiovascular medications as an independent correlate
to non-adherence behaviour. A secondary aim was to investigate about the usefulness
of a regimen review tool to detect non-adherence sensitively to each medication
within a complex prescribed package. This cross-sectional study was designed to test
factors that can be loaded under five dimensions of the World Health Organisation
model of long-term medication use. Across pilot test and two phases, the study
involved surveying 382 cardiac patients and reviewing of their medical files to get
the clinical data. Phase-I included 173 patients with different cardiac conditions to
demonstrate the validity of the regimen review tool and Phase-II involved 187
nondiabetic patients with stable IHD which comprised the main study. Parameters of
medication non-adherence, ED and sexual communication between cardiology
practitioners and patients were evaluated using structured instruments. In the main
study phase, the mean age of the 26–65 years old sexually active sample of patients
was 54.4 (±8.2). Average regimen complexity was 6.74 (2–13). Only 37 (19.8%)
patients were able to list down all their prescribed medications and 73 patients (39%)
had errors in taking their regimen accurately. Ninety six patients (51.3%) had poor
overall adherence and 46 (24.6%) had a history of medication discontinuation
without doctor’s consent. Among 90 patients (48.1%) who had skipped taking any
dose within the past two weeks of the survey day, forgetfulness and medication
adverse effects were the main reasons for non-adherence. Moderate to severe ED was
prevalent in 39.6% of the sample. The overwhelming majority of patients has not
been sexually counselled in the cardiology clinic whereas 71.7% reported being
comfortable to discuss sexual issues with the cardiologists. Multivariate logistic
regression analyses revealed four independent correlates to poor adherence and to
intentional non-adherence commonly. Those were wrong regimen intake, reporting
therapy-related barriers and adverse effects (such as ED), and use of anti-impotence
drugs. Use of diuretics was a predictor for ED diagnosis. These findings reveal a
high prevalence of ED among IHD patients but with a negligence of its treatment in
the cardiology practice. ED may undermine secondary preventive therapy use and
may trigger irrational use of anti-impotence drugs among patients. Reviewing the
regimen by pharmacists will help identifying patients who have underlying concerns
which are not easily being revealed such as sexual dysfunction. Assessment of
medication adherence should encompass multidimensional factors to cover the
variation of predicting intentional non-adherence to complex treatment.
Description
Keywords
Ischemic Heart Disease , effect of cardiovascular medications.